Provider Demographics
NPI:1740774074
Name:LAVALLE, KYLA
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:
Last Name:LAVALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 DELLA ROBIA CT
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-6141
Mailing Address - Country:US
Mailing Address - Phone:916-261-2910
Mailing Address - Fax:
Practice Address - Street 1:4713 DELLA ROBIA CT
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-6141
Practice Address - Country:US
Practice Address - Phone:916-261-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst