Provider Demographics
NPI:1740608900
Name:EMRY, KAYLEIGH
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:
Last Name:EMRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 SUTTER RD # B
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-4222
Mailing Address - Country:US
Mailing Address - Phone:707-496-8306
Mailing Address - Fax:
Practice Address - Street 1:770 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6210
Practice Address - Country:US
Practice Address - Phone:707-825-7588
Practice Address - Fax:707-825-8203
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96739106H00000X, 101YM0800X
CAIMF78104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health