Provider Demographics
NPI:1073292959
Name:JARRELLS, KAYLA MAREE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MAREE
Last Name:JARRELLS
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 1:1325 ELMWOOD CT APT 15
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1238
Mailing Address - Country:US
Mailing Address - Phone:586-372-5125
Mailing Address - Fax:
Practice Address - Street 1:1325 ELMWOOD CT APT 15
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1238
Practice Address - Country:US
Practice Address - Phone:586-372-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851113990104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker