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General NPI Number Information
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NPI Number | 1093678013
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Entity Type | Individual
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Provider Name | KAYLA CHEATHAM LSW
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Gender | Female
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 150 MERCURY VILLAGE DR
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City | DURANGO
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State | CO
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Zip | 81301-8955
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Country | US
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Telephone | 970-335-2422
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Fax |
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Provider Business Mailing Address
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Address Line | 205 COUNTY ROAD 224
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City | DURANGO
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State | CO
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Zip | 81301-7032
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Country | US
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Telephone | 901-283-9611
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW.0009927003
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License Number State | CO
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