Provider Demographics
NPI:1154637411
Name:PEREZ, KAYLA RENEE (BSW, MS)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BSW, MS
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:RENEE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:216 W A ST
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-4208
Mailing Address - Country:US
Mailing Address - Phone:580-774-9105
Mailing Address - Fax:
Practice Address - Street 1:115 1/2 EAST FIRST STREET
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-0000
Practice Address - Country:US
Practice Address - Phone:580-774-9105
Practice Address - Fax:580-547-4076
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101Y00000X
OKLPC06746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health