Provider Demographics
NPI:1902623739
Name:MERRITT, KAYLA LANAE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LANAE
Last Name:MERRITT
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 1:5233 MOHICAN WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8544
Mailing Address - Country:US
Mailing Address - Phone:925-331-7558
Mailing Address - Fax:
Practice Address - Street 1:5233 MOHICAN WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8544
Practice Address - Country:US
Practice Address - Phone:925-331-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician