Provider Demographics
NPI:1023624038
Name:HUMPHREY, KAYLA RAE (LSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RAE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:RAE
Other - Last Name:BUTTREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1033 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2409
Mailing Address - Country:US
Mailing Address - Phone:614-340-6777
Mailing Address - Fax:
Practice Address - Street 1:1033 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2409
Practice Address - Country:US
Practice Address - Phone:614-340-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1802428104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker