Provider Demographics
NPI:1417709288
Name:GOSNELL, KAYLA JANICE (MA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JANICE
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 BLAIR DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1409
Mailing Address - Country:US
Mailing Address - Phone:925-949-9631
Mailing Address - Fax:
Practice Address - Street 1:3625 E THOUSAND OAKS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3551
Practice Address - Country:US
Practice Address - Phone:805-225-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT145949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist