Provider Demographics
NPI:1730442104
Name:MCCUNE, KYLE NELSON
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:NELSON
Last Name:MCCUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4531
Mailing Address - Country:US
Mailing Address - Phone:503-983-1367
Mailing Address - Fax:
Practice Address - Street 1:437 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-4531
Practice Address - Country:US
Practice Address - Phone:503-983-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health