Kyle Scott Dickerson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

82938 Issued in CA

Practice address

3000 Joe Dimaggio Blvd Ste 1
Round Rock, TX 78665-3989

Phone

(512) 400-0196

NPI assigned

Nov 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 19, 2025 through Feb 19, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mesa View Counseling and Consulting PLLC

  • Marriage & Family Therapist
  • Round Rock, TX
  • NPI 1326914623
  NPD Authorized official
• Victor Community Support Services Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Victorville, CA
  • NPI 1629120498
  NPD (past)

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

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1366743346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 JOE DIMAGGIO BLVD STE 1",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 JOE DIMAGGIO BLVD STE 1",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653989",
            "telephone_number": "512-400-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "KYLE",
        "middle_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-08",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "82938",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "203128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Natasha Di Costanzo, DO
• David Alan Diaz, M.D.
• Monica Jeanette Diaz
• Monika Diaz, PHD
• Stacey Diaz
• Rebekah Rene Dickerson
• Sylvia Dickey Smith
• Dicomity Solutions
• Tracy Diep
• Samantha Dieterich, M.D.

• Marriage & Family Therapist in Round Rock, TX
• Providers in Round Rock, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.