Provider Demographics
NPI:1083154801
Name:SARGENT, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SARGENT
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 1:716 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-1117
Mailing Address - Country:US
Mailing Address - Phone:606-263-1549
Mailing Address - Fax:
Practice Address - Street 1:3651 HIGHWAY 2565
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-5018
Practice Address - Country:US
Practice Address - Phone:606-254-8959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
OHCDCA.182731101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No175T00000XOther Service ProvidersPeer Specialist