Provider Demographics
NPI:1083072151
Name:VENTRESS, KURISTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KURISTEN
Middle Name:
Last Name:VENTRESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4873 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802
Mailing Address - Country:US
Mailing Address - Phone:225-324-9582
Mailing Address - Fax:
Practice Address - Street 1:4873 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1031
Practice Address - Country:US
Practice Address - Phone:225-324-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA74641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical