Provider Demographics
NPI:1114599172
Name:FREEMAN, KAYLA LANE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LANE
Last Name:FREEMAN
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 1:3505 S LAMAR BLVD APT 2061
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7975
Mailing Address - Country:US
Mailing Address - Phone:312-465-6055
Mailing Address - Fax:
Practice Address - Street 1:4361 S CONGRESS AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1289
Practice Address - Country:US
Practice Address - Phone:512-710-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105280104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker