Provider Demographics
NPI:1386485274
Name:WILSON, KYLA
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PINE ROCK CT UNIT A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-3116
Mailing Address - Country:US
Mailing Address - Phone:501-712-6988
Mailing Address - Fax:
Practice Address - Street 1:320 PINE ROCK CT UNIT A
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-3116
Practice Address - Country:US
Practice Address - Phone:501-712-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool