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NPI Code Detail

MEDICARE: MISS KAYLA ELIZABETH POULSON MA, LPC, NCC

MEDICARE: MISS KAYLA ELIZABETH POULSON MA, LPC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor0016834CO

General Provider Information

NPI Number : 1003267121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KAYLA ELIZABETH POULSON MA, LPC, NCC
Provider Business Mailing Address
First Line : 1300 N 17TH AVE
Second Line :
City : GREELEY
State : CO
Zip : 80631-9584
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1300 N 17TH AVE
Second Line :
City : GREELEY
State : CO
Zip : 80631-9584
Country : US
Telephone Number : 970-302-9107
Fax Number : 970-353-3906
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2016
Last Update Date : 02/03/2021

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