Provider Demographics
NPI:1447011051
Name:KALEIDOSCOPE KIDS COUNSELING, LLC
Entity type:Organization
Organization Name:KALEIDOSCOPE KIDS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-656-1296
Mailing Address - Street 1:3545 ELLICOTT MILLS DR STE 302
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4517
Mailing Address - Country:US
Mailing Address - Phone:410-656-1296
Mailing Address - Fax:
Practice Address - Street 1:3545 ELLICOTT MILLS DR STE 302
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4517
Practice Address - Country:US
Practice Address - Phone:410-656-1296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty