MEDICARE: MRS. KAILEY KRUIS MA, LPCA

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	11601	SC

General Provider Information

NPI Number	:	1639928377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAILEY KRUIS MA, LPCA

Provider Business Mailing Address
First Line	:	337 VALLEY HEIGHTS LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5862
Country	:	US
Telephone Number	:	508-649-1581
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 VALLEY HEIGHTS LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5862
Country	:	US
Telephone Number	:	508-649-1581
Fax Number	:

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

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	04/08/2026

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