Provider Demographics
NPI:1861614075
Name:KYLE T MARTIN PHD PA
Entity type:Organization
Organization Name:KYLE T MARTIN PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-540-4400
Mailing Address - Street 1:7557 RAMBLER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4142
Mailing Address - Country:US
Mailing Address - Phone:214-540-4400
Mailing Address - Fax:214-540-4401
Practice Address - Street 1:7557 RAMBLER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4142
Practice Address - Country:US
Practice Address - Phone:214-540-4400
Practice Address - Fax:214-540-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23863103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty