Provider Demographics
NPI:1871000885
Name:MIRO, KAYLA LAUREN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:LAUREN
Last Name:MIRO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 N 60TH DR.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:802-779-1772
Mailing Address - Fax:
Practice Address - Street 1:300 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4103
Practice Address - Country:US
Practice Address - Phone:602-340-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2024-06-25
Deactivation Date:2024-05-24
Deactivation Code:
Reactivation Date:2024-06-24
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23099101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional