Provider Demographics
NPI:1306571211
Name:CARTER, KYLEE J (SWC)
Entity type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:J
Last Name:CARTER
Suffix:
Gender:F
Credentials:SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N MAIN ST STE 104LL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3179
Mailing Address - Country:US
Mailing Address - Phone:719-691-5206
Mailing Address - Fax:719-569-7974
Practice Address - Street 1:503 N MAIN ST STE 104LL
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3179
Practice Address - Country:US
Practice Address - Phone:719-691-5206
Practice Address - Fax:719-569-7974
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099304961041C0700X
CO00000007081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical