Provider Demographics
NPI:1467743948
Name:JOAN KAYLOR MSED NCC LICENSED PROFESSIONAL COUNSELOR LLC
Entity Type:Organization
Organization Name:JOAN KAYLOR MSED NCC LICENSED PROFESSIONAL COUNSELOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:724-942-5477
Mailing Address - Street 1:157 WATERDAM RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2573
Mailing Address - Country:US
Mailing Address - Phone:724-942-5477
Mailing Address - Fax:724-942-5479
Practice Address - Street 1:157 WATERDAM RD
Practice Address - Street 2:SUITE 260
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2573
Practice Address - Country:US
Practice Address - Phone:724-942-5477
Practice Address - Fax:724-942-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102268135Medicaid