Provider Demographics
NPI:1497230379
Name:SMIRNI, KYLA CHRISTINE
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:CHRISTINE
Last Name:SMIRNI
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 1:1858 PASEO SAN LUIS STE D
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5825
Mailing Address - Country:US
Mailing Address - Phone:509-637-0002
Mailing Address - Fax:
Practice Address - Street 1:1858 PASEO SAN LUIS STE D
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5825
Practice Address - Country:US
Practice Address - Phone:509-637-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60900695106S00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician