Provider Demographics
NPI:1598280570
Name:VANDER HAAR, KAYLA (LPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:VANDER HAAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 BLACK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-7745
Mailing Address - Country:US
Mailing Address - Phone:419-957-6937
Mailing Address - Fax:
Practice Address - Street 1:3292 BLACK HILLS DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-7745
Practice Address - Country:US
Practice Address - Phone:419-957-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500081101YP2500X
MI6401017893101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional