Basic Information
| Provider Information | |||||||||
| NPI: | 1851839963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAISER | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CSCAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10102 COUNTRY CLUB RD SE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215028339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017772285 | ||||||||
| FaxNumber: | 3017775832 | ||||||||
| Practice Location | |||||||||
| Address1: | 10102 COUNTRY CLUB RD SE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215028339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017772285 | ||||||||
| FaxNumber: | 3017775832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | SC0118 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.