Healthcare Provider Details

I. General information

NPI: 1720895808
Provider Name (Legal Business Name): KATIE ZYLICZ LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 S FOSTER DR STE 102
BATON ROUGE LA
70806-5945
US

IV. Provider business mailing address

6055 S POLLARD PKWY
BATON ROUGE LA
70808-7805
US

V. Phone/Fax

Practice location:
  • Phone: 225-505-9215
  • Fax:
Mailing address:
  • Phone: 225-505-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: