Provider Demographics
NPI:1558079616
Name:THOMAS, KYLA ANETRA (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:ANETRA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 GRANDLAKE BLVD APT G204
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1677
Mailing Address - Country:US
Mailing Address - Phone:504-451-6788
Mailing Address - Fax:
Practice Address - Street 1:3800 GRANDLAKE BLVD APT G204
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1677
Practice Address - Country:US
Practice Address - Phone:504-451-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical