Provider Demographics
NPI:1053122655
Name:KYLE, THERESA ANN (PHD EDUCATION)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:KYLE
Suffix:
Gender:F
Credentials:PHD EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 CASTLE GATE WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5570
Mailing Address - Country:US
Mailing Address - Phone:915-238-8679
Mailing Address - Fax:
Practice Address - Street 1:1766 CASTLE GATE WAY
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5570
Practice Address - Country:US
Practice Address - Phone:915-238-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46-03-1-37103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist