Provider Demographics
NPI:1821665654
Name:HARLESS, KAYLA MARIE ANN (MA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE ANN
Last Name:HARLESS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MARQUIS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-3713
Mailing Address - Country:US
Mailing Address - Phone:304-633-7359
Mailing Address - Fax:
Practice Address - Street 1:18 MARQUIS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-3713
Practice Address - Country:US
Practice Address - Phone:304-633-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)