Provider Demographics
NPI:1003317637
Name:KIRKPATRICK, THERESE I (LMSW)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:KIRKPATRICK
Suffix:I
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 BERTRAND DR STE E3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9105
Mailing Address - Country:US
Mailing Address - Phone:337-962-1987
Mailing Address - Fax:
Practice Address - Street 1:1304 BERTRAND DR STE E3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9105
Practice Address - Country:US
Practice Address - Phone:337-962-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010557591106S00000X
LA15656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician