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General NPI Number Information
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NPI Number | 1538850417
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Entity Type | Individual
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Provider Name | KELLEY TAYLOR LAC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 315 ALAMO ST
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8528
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Country | US
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Telephone | 337-226-7504
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Fax |
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Provider Business Mailing Address
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Address Line | 354 PINE RIDGE RD
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City | DERIDDER
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State | LA
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Zip | 70634-5350
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Country | US
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Telephone | 337-226-7504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5135
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License Number State | LA
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