Provider Demographics
NPI:1548930944
Name:ELLIS, KYLA D
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:D
Last Name:ELLIS
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 1:8758 WOLFF CT STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6904
Mailing Address - Country:US
Mailing Address - Phone:303-578-6336
Mailing Address - Fax:
Practice Address - Street 1:8758 WOLFF CT STE 205
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6904
Practice Address - Country:US
Practice Address - Phone:303-578-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)