Healthcare Provider Details

I. General information

NPI: 1386257392
Provider Name (Legal Business Name): KAYLA DANIELLE DROSCHA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA DANIELLE GIBSON-BECKNER

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 EAST PARIS AVE SE STE 203
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

620 PRAIRIE ST
CHARLOTTE MI
48813-1949
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-3784
  • Fax: 866-496-2998
Mailing address:
  • Phone: 517-588-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018542
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: