| NPI | 1538413752 |
|---|---|
| Former Name | KAYLA M THOMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 5430) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5430-125) |
| 101YP2500X Counselor, Professional (Licence: WI 921-226) | |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2019-12-11 |