| Doctor Name: | MR. JESSE JOSEPH KAULAITY |
| NPI Number: | 1215223458 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BSW |
| License Number: | |
| Business Practice Address: | Corner Of Route N12 And N7 Fort Defiance, AZ - 865040649 |
| Business Phone Number: | 9287298508 |
| Business Fax Number: | 9287298502 |
| Mailing Address: | Po Box 649, FORT DEFIANCE |
| State: | AZ |
| Postal Code: | 865040649 |
| Phone Number: | 9287298508 |
| Fax Number: | 9287298502 |
| NPI Enumeration Date: | 06/27/2011 |
| NPI Last Update Date: | 06/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |