Kylie Phelps, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

70475 Issued in TX

Practice address

3033 Campus Dr Ste W225
Minneapolis, MN 55441-2752

Phone

(415) 504-3838

Fax

(415) 504-1367

NPI assigned

Sep 9, 2016

Last updated

Aug 1, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Kylie Nicole Moore Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: kylie.phelps.1@30520.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1134676802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3189",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786672717",
            "telephone_number": "512-298-4854",
            "fax_number": "512-298-4854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 CAMPUS DR STE W225",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554412752",
            "telephone_number": "415-504-3838",
            "fax_number": "415-504-1367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "305 Ferguson Rd",
            "address_purpose": "LOCATION",
            "city": "Palestine",
            "state": "TX",
            "postal_code": "758036851",
            "country_code": "US",
            "telephone_number": "903-723-6136",
            "fax_number": "903-589-3443",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "209 Wisteria Way",
            "address_purpose": "LOCATION",
            "city": "San Marcos",
            "state": "TX",
            "postal_code": "786665282",
            "country_code": "US",
            "telephone_number": "512-298-4854",
            "fax_number": "512-298-4854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHELPS",
        "first_name": "KYLIE",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-09",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2022029205",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CO",
            "license": "0017923",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "70475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "MOORE",
            "middle_name": "NICOLE",
            "credential": "LPC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heidi Hongphuc Phan
• Linh Thuy Phan, RN
• Mia Phan, NP-C
• Brian Phaneuf, PTA
• Sidney Pharis, N.D.
• Ellen Pherson, RN
• Lisa Marie Phifer, MD
• Lisa Ann Philion Nelson, MPT
• Godbless Mathias Philipo
• Nicole Philipps, MD

• Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.