Provider Demographics
NPI:1083010540
Name:SOLA M. KIPPERS, PHD, LLC
Entity Type:Organization
Organization Name:SOLA M. KIPPERS, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-309-7844
Mailing Address - Street 1:6401 MAIN ST
Mailing Address - Street 2:TRAILER 14
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4062
Mailing Address - Country:US
Mailing Address - Phone:225-678-0844
Mailing Address - Fax:225-214-0068
Practice Address - Street 1:2924 BRAKLEY DR
Practice Address - Street 2:STE. B2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2333
Practice Address - Country:US
Practice Address - Phone:225-678-0810
Practice Address - Fax:225-214-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2417101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty