Provider Demographics
NPI:1649714569
Name:THOMAS, KAYLA DASHAY (BA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:DASHAY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 NW EXPRESSWAY
Mailing Address - Street 2:APT 16251
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1667
Mailing Address - Country:US
Mailing Address - Phone:347-694-9320
Mailing Address - Fax:
Practice Address - Street 1:4101 NW EXPRESSWAY
Practice Address - Street 2:APT 16251
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1667
Practice Address - Country:US
Practice Address - Phone:347-694-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst