Provider Demographics
NPI:1033802707
Name:MARTIN, KAYLA JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 PRESCOTT AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2258
Mailing Address - Country:US
Mailing Address - Phone:469-826-1193
Mailing Address - Fax:
Practice Address - Street 1:4001 W 15TH ST STE 465
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5845
Practice Address - Country:US
Practice Address - Phone:972-985-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical