Provider Demographics
NPI:1992390595
Name:HICKS, KAYLA JAYNE (MA, LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:JAYNE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA, LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ESK LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-3911
Mailing Address - Country:US
Mailing Address - Phone:218-340-7526
Mailing Address - Fax:
Practice Address - Street 1:2864 MIDDLE ST STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1411
Practice Address - Country:US
Practice Address - Phone:651-493-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304932101YA0400X
MN2540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)