Healthcare Provider Details

I. General information

NPI: 1275069700
Provider Name (Legal Business Name): MRS. KOLBI SENEGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 ABIGAYLES ROW
SCOTT LA
70582
US

IV. Provider business mailing address

124 ABIGAYLES ROW
SCOTT LA
70582
US

V. Phone/Fax

Practice location:
  • Phone: 337-739-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: