Individual
KAYLA SUANN PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4688 E MAJESTIC VIEW DR, IDAHO FALLS, ID 83406-8180
(580) 522-1119
Mailing address
4688 E MAJESTIC VIEW DR, IDAHO FALLS, ID 83406-8180
(580) 522-1119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
COUI-10305
ID
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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