Provider Demographics
NPI:1093471708
Name:CLARK, KAYLA ENNETTE (MS, LPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ENNETTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 HEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7393
Mailing Address - Country:US
Mailing Address - Phone:903-217-7629
Mailing Address - Fax:
Practice Address - Street 1:2800 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0128
Practice Address - Country:US
Practice Address - Phone:940-222-2399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional