Provider Demographics
NPI:1407177298
Name:GIFFORD, KYLA (LCSW)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0040
Mailing Address - Country:US
Mailing Address - Phone:970-945-2241
Mailing Address - Fax:970-945-5523
Practice Address - Street 1:439 BREEZE ST
Practice Address - Street 2:STE 200
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2650
Practice Address - Country:US
Practice Address - Phone:970-824-6541
Practice Address - Fax:970-824-0313
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical