Provider Demographics
NPI:1548977945
Name:RHEA, KYLE JOSEPH (SUDPT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:RHEA
Suffix:
Gender:M
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 FOXTAIL ST.
Mailing Address - Street 2:UNIT A
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264
Mailing Address - Country:US
Mailing Address - Phone:360-954-8621
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST STE 220
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5575
Practice Address - Country:US
Practice Address - Phone:360-954-8621
Practice Address - Fax:360-306-8374
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61316700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)