Provider Demographics
NPI:1134589617
Name:GRAMS, KAYLA BROOKE (MS LPC-MH)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:BROOKE
Last Name:GRAMS
Suffix:
Gender:F
Credentials:MS LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 NATIONAL ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-1833
Mailing Address - Country:US
Mailing Address - Phone:605-722-8090
Mailing Address - Fax:605-722-8090
Practice Address - Street 1:515 NATIONAL ST STE 103
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-1833
Practice Address - Country:US
Practice Address - Phone:605-722-8090
Practice Address - Fax:605-722-8090
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health