Provider Demographics
NPI:1184104150
Name:DRENNEN, KAYLA NICHOLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICHOLE
Last Name:DRENNEN
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 1:1714 GLENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5108
Mailing Address - Country:US
Mailing Address - Phone:336-251-8864
Mailing Address - Fax:
Practice Address - Street 1:11 S EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3918
Practice Address - Country:US
Practice Address - Phone:336-251-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health