Provider Demographics
NPI:1871283432
Name:EMORY, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:EMORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10327 GRAND RIVER RD STE 401
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6501
Mailing Address - Country:US
Mailing Address - Phone:800-787-5118
Mailing Address - Fax:
Practice Address - Street 1:4509 W MAIN ST APT C307
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2637
Practice Address - Country:US
Practice Address - Phone:216-269-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician