Provider Demographics
NPI:1649668237
Name:GOLDIN, KAYLA LYNN (BS)
Entity type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:LYNN
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38468 ALBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3201
Mailing Address - Country:US
Mailing Address - Phone:248-513-0905
Mailing Address - Fax:
Practice Address - Street 1:38468 ALBERT BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3201
Practice Address - Country:US
Practice Address - Phone:248-513-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11624031103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst