Provider Demographics
NPI:1811483647
Name:GREENHALGH, KYLI LAUREN (LAC)
Entity type:Individual
Prefix:
First Name:KYLI
Middle Name:LAUREN
Last Name:GREENHALGH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KYLI
Other - Middle Name:LAUREN
Other - Last Name:SKRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:510 S LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4726
Mailing Address - Country:US
Mailing Address - Phone:520-697-2341
Mailing Address - Fax:
Practice Address - Street 1:6280 E PIMA ST STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3074
Practice Address - Country:US
Practice Address - Phone:332-205-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-04
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA112152355S0801X
AZLAC-22522101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant