Healthcare Provider Details

I. General information

NPI: 1659266930
Provider Name (Legal Business Name): KAYLA RICO PLPC, M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAFAYETTE ST STE 118
GRETNA LA
70053-5732
US

IV. Provider business mailing address

829 AVENUE B
WESTWEGO LA
70094-4216
US

V. Phone/Fax

Practice location:
  • Phone: 504-276-5268
  • Fax:
Mailing address:
  • Phone: 504-202-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10661
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: