Healthcare Provider Details

I. General information

NPI: 1205488939
Provider Name (Legal Business Name): KAYLA CECILA MAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 FOLKER ST
ANCHORAGE AK
99508-5386
US

IV. Provider business mailing address

401 E MEMORIAL RD STE 700
OKLAHOMA CITY OK
73114-2287
US

V. Phone/Fax

Practice location:
  • Phone: 907-762-2865
  • Fax:
Mailing address:
  • Phone: 800-345-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number229449
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: