Healthcare Provider Details

I. General information

NPI: 1306337548
Provider Name (Legal Business Name): KATHERINE CULLEN HUNDLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 SAINT JOHN ST
LAFAYETTE LA
70501-6711
US

IV. Provider business mailing address

1015 SAINT JOHN ST
LAFAYETTE LA
70501-6711
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12266
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: