Provider Demographics
NPI:1831764497
Name:CRALL, KAYLA JOE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:JOE
Last Name:CRALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:KAYLA
Other - Middle Name:JOE
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MAURINE ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4620
Mailing Address - Country:US
Mailing Address - Phone:208-681-9443
Mailing Address - Fax:
Practice Address - Street 1:295 N 3855 E
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5124
Practice Address - Country:US
Practice Address - Phone:208-745-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-40667104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker