Provider Demographics
NPI:1104519859
Name:KAYLA PACIC COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:KAYLA PACIC COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-403-8464
Mailing Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5939
Mailing Address - Country:US
Mailing Address - Phone:313-403-8464
Mailing Address - Fax:
Practice Address - Street 1:3501 LAKE EASTBROOK BLVD SE STE 120
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5939
Practice Address - Country:US
Practice Address - Phone:313-403-8464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty