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General NPI Number Information
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NPI Number | 1164104949
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Entity Type | Individual
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Provider Name | KAYLA J GIBBONS LPC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 845 W CENTER ST
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City | POCATELLO
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State | ID
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Zip | 83204-4205
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Country | US
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Telephone | 208-729-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 921 S 8TH AVE BOX 8226
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City | POCATELLO
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State | ID
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Zip | 83209-0001
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Country | US
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Telephone | 832-585-7957
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Fax | 208-992-0241
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8331384
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License Number State | ID
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