Provider Demographics
NPI:1427660869
Name:ROULETTE, KAYLA R (MA, LCPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:R
Last Name:ROULETTE
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Gender:F
Credentials:MA, LCPC
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Mailing Address - Street 1:215 KADLEC DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3658
Mailing Address - Country:US
Mailing Address - Phone:618-581-3759
Mailing Address - Fax:
Practice Address - Street 1:16 EMERALD TER
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2321
Practice Address - Country:US
Practice Address - Phone:618-581-3759
Practice Address - Fax:618-410-0441
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health