Provider Demographics
NPI:1063059350
Name:JOHNSON, KAYLA MARTINEZ (PHD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MARTINEZ
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:SHINETTE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27708 TOMBALL PKWY
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6472
Mailing Address - Country:US
Mailing Address - Phone:903-424-6031
Mailing Address - Fax:
Practice Address - Street 1:12827 N WINDING PINES DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1858
Practice Address - Country:US
Practice Address - Phone:903-424-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist