Provider Demographics
NPI:1962147173
Name:LETHERWOOD, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LETHERWOOD
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 1:2200 N TORREY PINES DR APT 2141
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3387
Mailing Address - Country:US
Mailing Address - Phone:414-412-5377
Mailing Address - Fax:
Practice Address - Street 1:3131 W CRAIG RD STE 180
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0861
Practice Address - Country:US
Practice Address - Phone:733-165-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician