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General NPI Number Information
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NPI Number | 1013586684
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Entity Type | Individual
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Provider Name | KAYLA LYNN GROSSENBACHER LPC (C.2406461)
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Gender | Female
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 1433 5TH ST. NW
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City | NEW PHILADEPHIA
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State | OH
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Zip | 44663
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Country | US
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Telephone | 330-343-8171
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Fax | 330-409-9081
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Provider Business Mailing Address
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Address Line | 1433 5TH ST NW
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-1223
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Country | US
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Telephone | 330-204-4321
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Fax | 330-409-9081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162697
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.2406461
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License Number State | OH
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