Provider Demographics
NPI:1205226800
Name:BOUILLON, KARIS
Entity Type:Individual
Prefix:
First Name:KARIS
Middle Name:
Last Name:BOUILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARIS
Other - Middle Name:
Other - Last Name:HEINZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10211 SIEGEN LN STE 2A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4988
Mailing Address - Country:US
Mailing Address - Phone:225-769-2533
Mailing Address - Fax:
Practice Address - Street 1:10211 SIEGEN LN STE 2A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4988
Practice Address - Country:US
Practice Address - Phone:225-769-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLPC7994101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health