Provider Demographics
NPI:1861234809
Name:NICK, MCKAYLA (MS)
Entity type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:NICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MCKAYLA
Other - Middle Name:
Other - Last Name:BERRYHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:503 KAHLE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15864-3301
Mailing Address - Country:US
Mailing Address - Phone:814-316-1083
Mailing Address - Fax:
Practice Address - Street 1:30 GLADE RUN DR
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-2200
Practice Address - Country:US
Practice Address - Phone:724-452-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health