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General NPI Number Information
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NPI Number | 1962775213
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Entity Type | Individual
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Provider Name | KYLIE J LIDDLE MS, LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 12553 NEW BRITTANY BLVD # 32
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City | FORT MYERS
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State | FL
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Zip | 33907-3625
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Country | US
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Telephone | 727-490-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 1451 E WEHNER DR
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City | MADISON
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State | IN
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Zip | 47250-8601
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Country | US
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Telephone | 239-896-3194
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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 | 101YM0800X
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Taxonomy Name | Mental Health 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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH16282
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39004731A
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License Number State | IN
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