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General NPI Number Information
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NPI Number | 1235950775
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Entity Type | Organization
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Legal Business Name | KAYLA GIBBONS COUNSELING LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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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 | 208-992-0241
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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 | 83201-5377
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Country | US
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Telephone | 208-729-6041
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Fax | 208-992-0241
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Authorized Official
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Title or Position | OWNER
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Name | KAYLA J GIBBONS
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Credential | LCPC
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Telephone | 208-729-6041
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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 |
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License Number State |
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