Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | 0016834 | CO |
NPI | 1003267121 |
---|---|
Provider Name | Miss Kayla Elizabeth Poulson |
First Address | Greeley, CO 80631-9584 |
Second Address | Greeley, CO 80631-9584 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 03/02/2021 |