Provider Demographics
NPI:1659935690
Name:HORNE, KAYLA (LAC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2252 N 44TH ST APT 1014
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7201
Mailing Address - Country:US
Mailing Address - Phone:480-993-4688
Mailing Address - Fax:
Practice Address - Street 1:3303 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2739
Practice Address - Country:US
Practice Address - Phone:480-993-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17518101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor