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General NPI Number Information
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NPI Number | 1154025526
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Entity Type | Individual
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Provider Name | KAYLEE STILES LAC
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Gender | Female
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Dates
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Enumeration Date | 03/29/2023
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 492 ROUTE 57 W
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City | WASHINGTON
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State | NJ
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Zip | 07882-4411
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Country | US
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Telephone | 908-689-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 73 ALVIN SLOAN AVE
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City | WASHINGTON
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State | NJ
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Zip | 07882-4171
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Country | US
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Telephone | 908-635-6282
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00820500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2023-000111
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License Number State | NJ
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