Healthcare Provider Details

I. General information

NPI: 1992356489
Provider Name (Legal Business Name): KAYLA DANIELLE STEPHENS LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BELMONT AVE STE 3
SOMERSET KY
42501-2428
US

IV. Provider business mailing address

PO BOX 3044
WEST SOMERSET KY
42564-3044
US

V. Phone/Fax

Practice location:
  • Phone: 606-772-1030
  • Fax: 606-451-0558
Mailing address:
  • Phone: 606-687-2038
  • Fax: 606-200-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number244635
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: