Provider Demographics
NPI:1063085314
Name:NETTLETON, KAYLA (LCSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5954
Mailing Address - Country:US
Mailing Address - Phone:830-734-4303
Mailing Address - Fax:
Practice Address - Street 1:1401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-5954
Practice Address - Country:US
Practice Address - Phone:830-734-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health