Provider Demographics
NPI:1336821149
Name:BYRNES, KYLE (MLP)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:BYRNES
Suffix:
Gender:M
Credentials:MLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4594 TOWNLINE RD NW
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9447
Mailing Address - Country:US
Mailing Address - Phone:586-601-5495
Mailing Address - Fax:
Practice Address - Street 1:4594 TOWNLINE RD NW
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9447
Practice Address - Country:US
Practice Address - Phone:586-601-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical