Provider Demographics
NPI:1295474666
Name:VARGAS, KAYLA M (PHD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S ZEUS ST
Mailing Address - Street 2:
Mailing Address - City:MOXEE
Mailing Address - State:WA
Mailing Address - Zip Code:98936-8809
Mailing Address - Country:US
Mailing Address - Phone:509-201-2092
Mailing Address - Fax:
Practice Address - Street 1:108 S ZEUS ST
Practice Address - Street 2:
Practice Address - City:MOXEE
Practice Address - State:WA
Practice Address - Zip Code:98936-8809
Practice Address - Country:US
Practice Address - Phone:509-201-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61182606103TC1900X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling