Provider Demographics
NPI:1922845270
Name:BACON, KYLE EVAN (PSYD, LP, BCBA)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EVAN
Last Name:BACON
Suffix:
Gender:M
Credentials:PSYD, LP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2143
Mailing Address - Country:US
Mailing Address - Phone:720-468-9654
Mailing Address - Fax:
Practice Address - Street 1:550 THORNTON PKWY UNIT 234
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2167
Practice Address - Country:US
Practice Address - Phone:720-459-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-22-60816103K00000X
COPSY.0006420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst