Healthcare Provider Details

I. General information

NPI: 1013811934
Provider Name (Legal Business Name): KIDS FIRST THERAPY OF LOUISIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S FRANKLIN ST
BASTROP LA
71220-4533
US

IV. Provider business mailing address

420 S FRANKLIN ST
BASTROP LA
71220-4533
US

V. Phone/Fax

Practice location:
  • Phone: 318-536-2426
  • Fax:
Mailing address:
  • Phone: 318-536-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: LATOYA JACKSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-307-3017