Healthcare Provider Details

I. General information

NPI: 1740608900
Provider Name (Legal Business Name): KAYLEIGH EMRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 10TH ST
ARCATA CA
95521-6210
US

IV. Provider business mailing address

2332 MAPLE LN
EUREKA CA
95501-3313
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-7588
  • Fax: 707-825-8203
Mailing address:
  • Phone: 707-496-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT96739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF78104
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT96739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: