Provider Demographics
NPI:1205412400
Name:KYLA E WHITE LMHC PC
Entity Type:Organization
Organization Name:KYLA E WHITE LMHC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LADC
Authorized Official - Phone:508-422-0024
Mailing Address - Street 1:300 W MAIN ST STE A4
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2132
Mailing Address - Country:US
Mailing Address - Phone:508-422-0024
Mailing Address - Fax:
Practice Address - Street 1:300 W MAIN ST STE A4
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2132
Practice Address - Country:US
Practice Address - Phone:508-422-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health