Active NPI
Kayla Suann Petty
- Mental Health Counselor
- Idaho Falls, ID
National Provider Identifier
1689432759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- COUI-10305
- Practice address
- 4688 E Majestic View Dr
Idaho Falls, ID 83406-8180 - Phone
- (580) 522-1119
- NPI assigned
- Mar 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | COUI-10305 | ID | Primary |
Addresses
Primary practice location
4688 E Majestic View Dr
Idaho Falls, ID 83406-8180
Mailing address
4688 E Majestic View Dr
Idaho Falls, ID 83406-8180
Phone (580) 522-1119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COUI-10305 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710201600000",
"number": "1689432759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4688 E MAJESTIC VIEW DR",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834068180",
"telephone_number": "580-522-1119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4688 E MAJESTIC VIEW DR",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834068180",
"telephone_number": "580-522-1119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "KAYLA",
"middle_name": "SUANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-03-12",
"last_updated": "2024-03-12",
"certification_date": "2024-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "COUI-10305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.