Individual
KYLA THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2013 S ANTHONY BLVD, FORT WAYNE, IN 46803-3609
(260) 255-3514
Mailing address
2013 S ANTHONY BLVD, FORT WAYNE, IN 46803-3609
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
88002138A
IN
Other
Enumeration date
12/04/2023
Last updated
12/04/2023
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