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General NPI Number Information
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NPI Number | 1760694616
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Entity Type | Individual
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Provider Name | KATHRYN MICHELE MACAULAY LMFT, LPC,NCC,CCMHC
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | OVERTON BROOKS VA MEDICAL CENTER 510 EAST STONER AVENUE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4295
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Country | US
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Telephone | 318-221-8411
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Fax |
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Provider Business Mailing Address
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Address Line | 510 E STONER AVE
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City | SHREVEPORT
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State | LA
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Zip | 71101-4243
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Country | US
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Telephone | 318-221-8411
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3290
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT1043
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License Number State | LA
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