Provider Demographics
NPI:1831799006
Name:MASIYA, KYLEE (LPCC)
Entity type:Individual
Prefix:MS
First Name:KYLEE
Middle Name:
Last Name:MASIYA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 STEINBECK WAY APT E
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-8728
Mailing Address - Country:US
Mailing Address - Phone:937-679-6047
Mailing Address - Fax:
Practice Address - Street 1:1237 STEINBECK WAY APT E
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-8728
Practice Address - Country:US
Practice Address - Phone:937-679-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800719101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional