Provider Demographics
NPI:1437521127
Name:GOWIN, KAYLA (LAC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GOWIN
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 1:2215 E OAK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4644
Mailing Address - Country:US
Mailing Address - Phone:501-336-0511
Mailing Address - Fax:501-336-4037
Practice Address - Street 1:2215 E OAK ST STE 1
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4644
Practice Address - Country:US
Practice Address - Phone:501-336-0511
Practice Address - Fax:501-336-4037
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1611148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health