=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194326637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAYLA WRIGHT COUNSELING, P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2020
-----------------------------------------------------
Last Update Date | 11/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 N MOORE AVE STE 15
-----------------------------------------------------
City | MOORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73160-3612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-277-0482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3139 SW 103RD ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73159-6041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-837-6681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ALCOHOL, DRUG, AND MH
-----------------------------------------------------
Name | MRS. KAYLA RENEE HIGNITE
-----------------------------------------------------
Credential | LADC/MH
-----------------------------------------------------
Telephone | 405-837-6681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------