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General NPI Number Information
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NPI Number | 1871141986
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Entity Type | Organization
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Legal Business Name | KIDDOS THERAPY KONNECTION LLC
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Dates
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Enumeration Date | 09/01/2019
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 814 W MCNEESE ST # 241
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5426
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Country | US
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Telephone | 337-502-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 814 W MCNEESE ST # 241
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5426
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLIE COCHRAN JR.
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Credential |
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Telephone | 337-502-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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