Individual
KYLIE CASEBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 SE ADAMS AVE, CHEHALIS, WA 98532-3031
(360) 280-8116
Mailing address
505 SE ADAMS AVE, CHEHALIS, WA 98532-3031
(360) 280-8116
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
CO61277888
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
ABHS
WA
01
—
CO61277888
NA
WA
Enumeration date
10/20/2022
Last updated
10/20/2022
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