Healthcare Provider Details

I. General information

NPI: 1164023396
Provider Name (Legal Business Name): KAYLA KONISH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA KINWORTHY PHD

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 KING AVE
CORCORAN CA
93212-9611
US

IV. Provider business mailing address

677 MONTANA DE ORO ST
TULARE CA
93274-7403
US

V. Phone/Fax

Practice location:
  • Phone: 805-760-0746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number32183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: