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General NPI Number Information
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NPI Number | 1548728215
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Entity Type | Individual
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Provider Name | KAYLA CLOSE-STALLWORTH MA,LLPC
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Gender | Female
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 29425 NORTHWESTERN HWY STE 210
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1000
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Country | US
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Telephone | 248-327-7409
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Fax |
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Provider Business Mailing Address
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Address Line | 25304 SHIAWASSEE CIR APT 205
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3852
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Country | US
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Telephone | 313-680-2924
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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 | 6451022781
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451022781
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License Number State | MI
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