Kylie J Liddle, MS, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39004731A Issued in IN

Practice address

12553 New Brittany Blvd # 32
Fort Myers, FL 33907-3625

Phone

(727) 490-8513

NPI assigned

Feb 17, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Dale, IN
  • NPI 1639029283
  NPD
• Lifespring, Inc

  • Community/Behavioral Health Agency
  • Jeffersonville, IN
  • NPI 1851489942
  NPD

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

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1962775213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 E WEHNER DR",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472508601",
            "telephone_number": "239-896-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12553 NEW BRITTANY BLVD # 32",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073625",
            "telephone_number": "727-490-8513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3008 Bevcher Dr",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "IN",
            "postal_code": "472503863",
            "country_code": "US",
            "telephone_number": "812-265-1918",
            "fax_number": "812-265-1828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIDDLE",
        "first_name": "KYLIE",
        "middle_name": "J",
        "credential": "MS, LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-17",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH16282",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39004731A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962775213",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Paul Liccini, M.D.
• Elizabeth De la Caridad Licea Fornaris
• Bryan V Lich, CCP
• Kathy Lichter, P.T.A.
• Maribeth Lichty, ACSW,LCSW,CAP
• Amanda Lidgard, DO
• Claude P Lieber, MD
• Mark Ernest Liebetreu, OD
• Fred A Liebowitz, M.D.
• Katherine Lietz, MD PHD

• Mental Health Counselor in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.