Healthcare Provider Details

I. General information

NPI: 1669935755
Provider Name (Legal Business Name): KAYLA LOIS POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA FARNER

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 S 85TH ST
WEST ALLIS WI
53214-4453
US

IV. Provider business mailing address

1640 S 85TH ST
WEST ALLIS WI
53214-4453
US

V. Phone/Fax

Practice location:
  • Phone: 262-344-4529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC14250
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11180-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT136983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: