NPIMap

Individual provider Active NPI

Marjorie Teresa Kyle, PSY.D.

  • Counseling Psychologist
  • Jber, AK
National Provider Identifier
1487696795
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
628 Issued in AK
Practice address
4982 Zukert Ave
RM 126
Jber, AK 99505
Phone
(907) 580-0715
Fax
(907) 580-0629
NPI assigned
Jun 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 31369 TX
Counseling Psychologist 103TC1900X 628 AK Primary

Addresses

Primary practice location

4982 Zukert Ave
RM 126
Jber, AK 99505

Mailing address

3705 Arctic Blvd # 406
Anchorage, AK 99503-5774
Phone (607) 230-2190

Other practice location 1

4982 Zukert Ave
Rm 126
Jber, AK 99505
Phone (907) 580-0715

Other identifiers 2

IdentifierTypeStateIssuer
1724726MedicaidTX
628OtherAKBOARD OF PSYCHOLOGIST

Other names 1

  • Dr. Marjorie Teresa Kyle Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31369TXMDClinical Child & Adolescent Psychologist
628AKMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cygnet Psychological Services LLC Current Accepting new patients
Cygnet Psychological Services LLC Current Accepting new patients
Rosa Verde Family Health Group Past Accepting new patients
Cristo Rey Clinic, PA PastSince Nov 1, 2007 Accepting new patients
South Central Texas Psychological Associates Past Accepting new patients

Locations

3705 Artic Blvd
Anchorage, AK 99503
Phone (425) 645-1548

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1487696795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 ARCTIC BLVD # 406",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995035774",
            "telephone_number": "607-230-2190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4982 ZUKERT AVE",
            "address_2": "RM 126",
            "city": "JBER",
            "state": "AK",
            "postal_code": "99505",
            "telephone_number": "907-580-0715",
            "fax_number": "907-580-0629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4982 Zukert Ave",
            "address_2": "Rm 126",
            "address_purpose": "LOCATION",
            "city": "JBER",
            "state": "AK",
            "postal_code": "99505",
            "country_code": "US",
            "telephone_number": "907-580-0715",
            "fax_number": "907-580-0629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KYLE",
        "first_name": "MARJORIE",
        "middle_name": "TERESA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "31369",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "AK",
            "license": "628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1724726",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PSYCHOLOGIST",
            "identifier": "628",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARJORIE",
            "last_name": "KYLE",
            "middle_name": "TERESA",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jber, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.