Provider Demographics
NPI:1285982603
Name:HILL, KYLE XAVIER (PHD)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:XAVIER
Last Name:HILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E 24TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3959
Mailing Address - Country:US
Mailing Address - Phone:612-721-9884
Mailing Address - Fax:612-721-7870
Practice Address - Street 1:1315 E 24TH ST STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-721-9884
Practice Address - Fax:612-721-7870
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical