Healthcare Provider Details

I. General information

NPI: 1609677210
Provider Name (Legal Business Name): KATAYA LYNN FRYAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 VETERANS BLVD STE A
DENHAM SPRINGS LA
70726-4725
US

IV. Provider business mailing address

230 VETERANS BLVD STE A
DENHAM SPRINGS LA
70726-4725
US

V. Phone/Fax

Practice location:
  • Phone: 225-612-8656
  • Fax:
Mailing address:
  • Phone: 225-612-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10605
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: