Provider Demographics
NPI:1598475840
Name:HARRIS, KAYLA RENEA (ALMFT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ALMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 N LA SALLE DR APT 3409
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6026
Mailing Address - Country:US
Mailing Address - Phone:779-200-1875
Mailing Address - Fax:
Practice Address - Street 1:1757 N KIMBALL AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4805
Practice Address - Country:US
Practice Address - Phone:312-768-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000841106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty