Healthcare Provider Details

I. General information

NPI: 1275347734
Provider Name (Legal Business Name): KAYLA D. HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 FLOYD PARK DR STE 4
RUSTON LA
71270-6631
US

IV. Provider business mailing address

126 GODCHAUX DR
RUSTON LA
71270-7442
US

V. Phone/Fax

Practice location:
  • Phone: 318-406-9080
  • Fax:
Mailing address:
  • Phone: 919-725-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10281
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10281
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: