Provider Demographics
NPI:1497251144
Name:ST. CLAIR, KYLANI
Entity type:Individual
Prefix:MRS
First Name:KYLANI
Middle Name:
Last Name:ST. CLAIR
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 1:19709 BOTHELL EVERETT HWY APT 324
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8151
Mailing Address - Country:US
Mailing Address - Phone:425-248-1611
Mailing Address - Fax:
Practice Address - Street 1:19709 BOTHELL EVERETT HWY APT 324
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8151
Practice Address - Country:US
Practice Address - Phone:425-248-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH611143579101Y00000X
WALH61113579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA871505646OtherTAX ID