Healthcare Provider Details

I. General information

NPI: 1144833906
Provider Name (Legal Business Name): KELLI CAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 09/23/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 DOC PREJEAN ST
SCOTT LA
70583-5133
US

IV. Provider business mailing address

100 ASMA BLVD STE 200
LAFAYETTE LA
70508-3868
US

V. Phone/Fax

Practice location:
  • Phone: 337-804-3283
  • Fax:
Mailing address:
  • Phone: 337-804-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: