Provider Demographics
NPI:1982370433
Name:THYNG, KAYLA PELLAR
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:PELLAR
Last Name:THYNG
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 1:11021 CROSSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-8683
Mailing Address - Country:US
Mailing Address - Phone:517-499-1709
Mailing Address - Fax:
Practice Address - Street 1:88 PANTHER DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-2601
Practice Address - Country:US
Practice Address - Phone:931-738-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN146922805101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN146922805OtherDRIVERS LICENSE NUMBER