Healthcare Provider Details

I. General information

NPI: 1750705935
Provider Name (Legal Business Name): KAY DORE COUNSELING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 RYAN ST BOX 91895
LAKE CHARLES LA
70609-1895
US

IV. Provider business mailing address

4205 RYAN ST BOX 91895
LAKE CHARLES LA
70609-1895
US

V. Phone/Fax

Practice location:
  • Phone: 337-475-5981
  • Fax: 337-562-4221
Mailing address:
  • Phone: 337-475-5981
  • Fax: 337-562-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS JOANNA THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-475-5981