Healthcare Provider Details

I. General information

NPI: 1326489402
Provider Name (Legal Business Name): ALEXIS KATERIDGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 GATEWAY DR
SLIDELL LA
70461-5589
US

IV. Provider business mailing address

350 GATEWAY DR
SLIDELL LA
70461-5589
US

V. Phone/Fax

Practice location:
  • Phone: 985-707-1410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8159
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: