Individual
MR. JESSE JOSEPH KAULAITY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8508
(928) 729-8502
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8508
(928) 729-8502
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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