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General NPI Number Information
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NPI Number | 1558036335
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Entity Type | Individual
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Provider Name | KAYLA COUNTRYMAN
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 1651 RESPONSE RD STE 111
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City | SACRAMENTO
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State | CA
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Zip | 95815-5254
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Country | US
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Telephone | 916-838-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 475 HARTNELL PL
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City | SACRAMENTO
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State | CA
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Zip | 95825-6615
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Country | US
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Telephone | 916-838-1005
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 140338
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License Number State | CA
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