Provider Demographics
NPI:1790412153
Name:PHILLIPS, KAYLA (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 S CANTON AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3430
Mailing Address - Country:US
Mailing Address - Phone:918-745-0095
Mailing Address - Fax:918-745-0190
Practice Address - Street 1:6846 S CANTON AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3430
Practice Address - Country:US
Practice Address - Phone:918-745-0095
Practice Address - Fax:918-745-0190
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional