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Individual

KAYLA ELLINGSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ACMHC

Contact information

Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(476) 080-1373
(817) 373-0639
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
(801) 373-0639

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
101YA0400X
Addiction (Substance Use Disorder) Counselor
12355694-6017
UT
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO60940944
WA
101YM0800X
Mental Health Counselor
12355694-6009
UT
101YM0800X
Mental Health Counselor
MC61080470
WA
101YP2500X
Professional Counselor
Primary
12355694-6009
UT
171M00000X
Case Manager/Care Coordinator

Other

Enumeration date
06/23/2020
Last updated
04/03/2024
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