Provider Demographics
NPI:1023890134
Name:MOSBY, KYLA DAWN (MA)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:DAWN
Last Name:MOSBY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:DAWN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:NORTH SAN JUAN
Mailing Address - State:CA
Mailing Address - Zip Code:95960-0949
Mailing Address - Country:US
Mailing Address - Phone:415-717-8523
Mailing Address - Fax:
Practice Address - Street 1:547 UREN ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2334
Practice Address - Country:US
Practice Address - Phone:530-270-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist