Provider Demographics
NPI:1649760158
Name:CRATTY, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CRATTY
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 1:5940 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2506
Mailing Address - Country:US
Mailing Address - Phone:888-531-8385
Mailing Address - Fax:925-264-1902
Practice Address - Street 1:5940 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2506
Practice Address - Country:US
Practice Address - Phone:888-531-8385
Practice Address - Fax:925-264-1902
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-18-55412106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician