Provider Demographics
NPI:1619536588
Name:WOOLERY, KAYDIAN TASHINA (MHC)
Entity Type:Individual
Prefix:
First Name:KAYDIAN
Middle Name:TASHINA
Last Name:WOOLERY
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 SYVELLA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8405
Mailing Address - Country:US
Mailing Address - Phone:347-517-9485
Mailing Address - Fax:
Practice Address - Street 1:3455 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5118
Practice Address - Country:US
Practice Address - Phone:347-517-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional