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General NPI Number Information
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NPI Number | 1689991838
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Entity Type | Individual
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Provider Name | KASHON CORLEY LPC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 2435 DRUSILLA LN
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City | BATON ROUGE
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State | LA
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Zip | 70809
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Country | US
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Telephone | 225-364-2090
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Fax | 225-208-1301
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Provider Business Mailing Address
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Address Line | PO BOX 45703
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City | BATON ROUGE
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State | LA
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Zip | 70895-4703
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Country | US
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Telephone | 225-636-1708
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Fax | 225-930-4944
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4169
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License Number State | LA
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