Healthcare Provider Details

I. General information

NPI: 1821571720
Provider Name (Legal Business Name): KAIROS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 W CONGRESS ST
LAFAYETTE LA
70506-6622
US

IV. Provider business mailing address

4640 W CONGRESS ST
LAFAYETTE LA
70506-6622
US

V. Phone/Fax

Practice location:
  • Phone: 337-210-5844
  • Fax: 225-214-1655
Mailing address:
  • Phone: 337-210-5844
  • Fax: 225-214-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6343
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA LEGE
Title or Position: OWNER
Credential: MS,LPC
Phone: 337-278-8193