Individual
KYLE ROUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
7165 GETWELL RD, SOUTHAVEN, MS 38672-9618
(601) 790-0583
Mailing address
5295 PAYTON DR W, SOUTHAVEN, MS 38671-8428
(601) 790-0583
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2576
MS
101YM0800X
Mental Health Counselor
A1610132
AR
Other
Enumeration date
11/21/2017
Last updated
08/11/2020
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