Provider Demographics
NPI:1104576479
Name:KAYLA EDSON, PLLC
Entity type:Organization
Organization Name:KAYLA EDSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:970-834-3657
Mailing Address - Street 1:4689 W 20TH STREET
Mailing Address - Street 2:SUITE E
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634
Mailing Address - Country:US
Mailing Address - Phone:970-834-3657
Mailing Address - Fax:
Practice Address - Street 1:4689 W 20TH STREET
Practice Address - Street 2:SUITE E
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
Practice Address - Country:US
Practice Address - Phone:970-834-3657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
62308OtherCIGNA
60054OtherAETNA
CORMHMOMedicaid
COCOACCMedicaid
87726OtherUNITED HEALTH CARE
CO00813Medicaid
CO9000177607Medicaid