Provider Demographics
NPI:1922427087
Name:KENLY, KAYLA
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:KENLY
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 1:833 ASPEN PEAK LOOP
Mailing Address - Street 2:UNIT 2714
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1803
Mailing Address - Country:US
Mailing Address - Phone:702-803-0432
Mailing Address - Fax:
Practice Address - Street 1:833 ASPEN PEAK LOOP
Practice Address - Street 2:UNIT 2714
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-1803
Practice Address - Country:US
Practice Address - Phone:702-803-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health