Healthcare Provider Details

I. General information

NPI: 1760977953
Provider Name (Legal Business Name): KAYLA CHRISTINE ALLRED LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 PROSPERITY LAKE DR BLDG 101
SAINT AUGUSTINE FL
32092-5045
US

IV. Provider business mailing address

495 PROSPERITY LAKE DR BLDG 101
SAINT AUGUSTINE FL
32092-5045
US

V. Phone/Fax

Practice location:
  • Phone: 904-370-3420
  • Fax:
Mailing address:
  • Phone: 904-370-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: