Provider Demographics
NPI:1821416074
Name:GRUBER, KAYLA (LPCC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-4017
Mailing Address - Country:US
Mailing Address - Phone:320-616-1360
Mailing Address - Fax:
Practice Address - Street 1:107 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-4017
Practice Address - Country:US
Practice Address - Phone:320-616-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00760101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional