Provider Demographics
NPI:1720979545
Name:PULPHUS, KAYLIKA BRE'NAY
Entity type:Individual
Prefix:
First Name:KAYLIKA
Middle Name:BRE'NAY
Last Name:PULPHUS
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 1:711 LAKE HARBOUR DR APT 1161
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4309
Mailing Address - Country:US
Mailing Address - Phone:662-308-8520
Mailing Address - Fax:
Practice Address - Street 1:359 TOWNE CENTER BLVD STE 601
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4862
Practice Address - Country:US
Practice Address - Phone:769-225-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSBACB1380602106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician