Provider Demographics
NPI:1326778309
Name:GEHLE, KAYLA (LISW-S, CCTP-II)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GEHLE
Suffix:
Gender:F
Credentials:LISW-S, CCTP-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 QUEENS XING
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4215
Mailing Address - Country:US
Mailing Address - Phone:937-397-3666
Mailing Address - Fax:
Practice Address - Street 1:207 QUEENS XING
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-4215
Practice Address - Country:US
Practice Address - Phone:937-397-3666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20023221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical