MEDICARE: KAY DORE COUNSELING CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750705935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAY DORE COUNSELING CLINIC

Provider Business Mailing Address
First Line	:	4205 RYAN ST
Second Line	:	BOX 91895
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609-1895
Country	:	US
Telephone Number	:	337-475-5981
Fax Number	:	337-562-4221

Provider Business Practice Location Address
First Line	:	4205 RYAN ST
Second Line	:	BOX 91895
City	:	LAKE CHARLES
State	:	LA
Zip	:	70609-1895
Country	:	US
Telephone Number	:	337-475-5981
Fax Number	:	337-562-4221

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MISS JOANNA THOMPSON
Credential	:
Telephone Number	:	337-475-5981

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	02/10/2014

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Directions to “KAY DORE COUNSELING CLINIC ” Practice Location

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