Provider Demographics
NPI:1356018758
Name:LINDSAY, KAYLEIGH (LAC)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 N 170TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-1832
Mailing Address - Country:US
Mailing Address - Phone:765-860-0226
Mailing Address - Fax:
Practice Address - Street 1:17290 N 170TH LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-1832
Practice Address - Country:US
Practice Address - Phone:765-860-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-18892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional