Provider Demographics
NPI:1467477141
Name:WEINER, KAYLA MIRIYAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MIRIYAM
Last Name:WEINER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 46303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-0303
Mailing Address - Country:US
Mailing Address - Phone:206-343-0828
Mailing Address - Fax:
Practice Address - Street 1:1424 4TH AVE
Practice Address - Street 2:SUITE 912
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2297
Practice Address - Country:US
Practice Address - Phone:206-343-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00003674OtherMENTAL HEALTH COUNSELOR