Provider Demographics
NPI:1366878118
Name:AVERY, KAYLA (LPC-MHSP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 2516 22ND ST.
Mailing Address - Street 2:
Mailing Address - City:FT. CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5650
Mailing Address - Country:US
Mailing Address - Phone:270-798-0900
Mailing Address - Fax:
Practice Address - Street 1:BLDG 2516 22ND ST.
Practice Address - Street 2:
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5650
Practice Address - Country:US
Practice Address - Phone:270-798-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health