MEDICARE: MRS. KAYLA STARBUCK CPCI

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
1	101YM0800X	Mental Health Counselor	CI5429	NV

General Provider Information

NPI Number	:	1124845367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLA STARBUCK CPCI

Provider Business Mailing Address
First Line	:	10795 W TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10795 W TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3042
Country	:	US
Telephone Number	:	702-941-0345
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	09/19/2024

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