Healthcare Provider Details

I. General information

NPI: 1447814447
Provider Name (Legal Business Name): KRISTEN AQUINO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 INDIANA AVE
KENNER LA
70065-4605
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 504-575-3712
  • Fax: 504-575-3691
Mailing address:
  • Phone: 504-575-3712
  • Fax: 504-575-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC-581
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: