Provider Demographics
NPI:1053099325
Name:SMITH, KAYLA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2428
Mailing Address - Country:US
Mailing Address - Phone:570-565-9222
Mailing Address - Fax:570-227-2008
Practice Address - Street 1:455 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2428
Practice Address - Country:US
Practice Address - Phone:570-565-9222
Practice Address - Fax:570-227-2008
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017724101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty