Provider Demographics
NPI:1932825148
Name:MEDARIS, KAYLA (LMHCA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MEDARIS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 TESTIMONY AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8472
Mailing Address - Country:US
Mailing Address - Phone:317-417-1208
Mailing Address - Fax:
Practice Address - Street 1:970 LOGAN ST STE 110
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2253
Practice Address - Country:US
Practice Address - Phone:317-760-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001718A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health