Provider Demographics
NPI:1164023396
Name:KONISH, KAYLA (PHD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KONISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:KINWORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:677 MONTANA DE ORO ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 KING AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-9611
Practice Address - Country:US
Practice Address - Phone:805-760-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32183103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical