Individual
KYLE DAWALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11324 CRESSKILL CT, FORT WAYNE, IN 46845-2008
(574) 551-6673
Mailing address
11324 CRESSKILL CT, FORT WAYNE, IN 46845-2008
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/29/2022
Last updated
07/01/2022
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