Provider Demographics
NPI:1225689938
Name:KAYLAN NICHOLE CORPORATION
Entity Type:Organization
Organization Name:KAYLAN NICHOLE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYLAN
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:DIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-816-3903
Mailing Address - Street 1:10436 SANTA MONICA BLVD STE 3010
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5079
Mailing Address - Country:US
Mailing Address - Phone:559-816-3903
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD STE 3010
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5079
Practice Address - Country:US
Practice Address - Phone:559-816-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty