Kyle O Lythgoe, PSYD
Individual provider Active NPI Clinical Psychologist · Fort Meade, SD
NPI 1174525653 · NPPES record last updated Mar 19, 2024
Key facts
- NPI
- 1174525653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 554 (NE)
- Practice address
- 113 Comanche Rd
Fort Meade, SD 57741-1002 - Phone
- (605) 347-2511
- NPI assigned
- Aug 15, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 554 | NE | MD | Emergency Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 554 | NE | |
| Clinical Psychologist | 103TC0700X | 554 | NE | Yes |
Addresses
Primary practice location
113 Comanche Rd
Fort Meade, SD 57741-1002
Mailing address
113 Comanche Rd
Fort Meade, SD 57741-1002
Phone (605) 347-2511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08436 | Other | NE | BLUE CROSS BLUE SHIELD NE |
Other providers in Fort Meade, SD
- Monte Lindmier
- Donald Keith Lindsay
- Desirae Lynn Lloyd
- Janelle Lothspeich
- Rebecca Lynn Lunders
- James A Maas
- Celeste Adele Magnusson
- Shelby Markworth
- Kelly Bryce Maser
- Steven Alexander Massopust
All providers in Fort Meade, SD · Clinical Psychologist in South Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.