Provider Demographics
NPI:1871311365
Name:HENNELLY, KAYLA (LMFTA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HENNELLY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 STURDY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7829
Mailing Address - Country:US
Mailing Address - Phone:219-531-0111
Mailing Address - Fax:
Practice Address - Street 1:1551 STURDY RD STE 3
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7829
Practice Address - Country:US
Practice Address - Phone:219-531-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99126699A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist