Healthcare Provider Details

I. General information

NPI: 1821387556
Provider Name (Legal Business Name): KRISTEN RZOMP LADNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21257 W MITCHELL RD
SAUCIER MS
39574-9178
US

IV. Provider business mailing address

21257 W MITCHELL RD
SAUCIER MS
39574-9178
US

V. Phone/Fax

Practice location:
  • Phone: 228-224-1082
  • Fax:
Mailing address:
  • Phone: 228-224-1082
  • Fax: 228-224-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1535
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: