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General NPI Number Information
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NPI Number | 1962058602
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Entity Type | Individual
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Provider Name | KYLE DUMAS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 8912 VOLUNTEER LN
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City | SACRAMENTO
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State | CA
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Zip | 95826-3221
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Country | US
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Telephone | 916-344-0199
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 22996
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City | SACRAMENTO
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State | CA
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Zip | 95822-0996
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 91637
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License Number State | CA
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