Provider Demographics
NPI:1871260661
Name:BUELTEL, KAYLA LORRAINE (MA, PPS, LEP4106)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:LORRAINE
Last Name:BUELTEL
Suffix:
Gender:F
Credentials:MA, PPS, LEP4106
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3531
Mailing Address - Country:US
Mailing Address - Phone:661-588-6000
Mailing Address - Fax:
Practice Address - Street 1:2553 OLD FARM RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3531
Practice Address - Country:US
Practice Address - Phone:661-588-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP4106103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool