Provider Demographics
NPI:1013586684
Name:GROSSENBACHER, KAYLA LYNN (CT (COUNSELOR TRAINE)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYNN
Last Name:GROSSENBACHER
Suffix:
Gender:F
Credentials:CT (COUNSELOR TRAINE
Other - Prefix:
Other - First Name:CT (COUNSELOR TRAINE
Other - Middle Name:LYNN
Other - Last Name:GROSSENBACHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC III
Mailing Address - Street 1:233 1ST DR. NE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADEPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663
Mailing Address - Country:US
Mailing Address - Phone:330-204-4321
Mailing Address - Fax:330-409-9081
Practice Address - Street 1:1433 5TH ST. NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADEPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663
Practice Address - Country:US
Practice Address - Phone:330-343-8171
Practice Address - Fax:330-409-9081
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.175011101YA0400X
OHLCDCIII.162550101YA0400X
OHC.2305018-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCDCA.175011OtherCDCA