Healthcare Provider Details

I. General information

NPI: 1255789517
Provider Name (Legal Business Name): KAYLA JENN KEREKES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 CHAMPA ST
DENVER CO
80205-2529
US

IV. Provider business mailing address

2111 CHAMPA ST
DENVER CO
80205-2529
US

V. Phone/Fax

Practice location:
  • Phone: 303-312-2217
  • Fax: 303-293-2309
Mailing address:
  • Phone: 303-312-2217
  • Fax: 303-293-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSW.0009920697
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09925919
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: