Provider Demographics
NPI:1326518333
Name:HANSON, KAYLA LYN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LYN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14951 WALDEN SPRINGS WAY APT 824
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1189
Mailing Address - Country:US
Mailing Address - Phone:904-864-6186
Mailing Address - Fax:
Practice Address - Street 1:1400 OLD DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5733
Practice Address - Country:US
Practice Address - Phone:904-829-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH16399OtherLICENSED MENTAL HEALTH COUNSELOR