Provider Demographics
NPI:1326605643
Name:KILBOURNE, FALYSIA TATE
Entity Type:Individual
Prefix:MRS
First Name:FALYSIA
Middle Name:TATE
Last Name:KILBOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:FALYSIA
Other - Middle Name:CHANNEL
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 MCGEHEE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5012
Mailing Address - Country:US
Mailing Address - Phone:225-275-7273
Mailing Address - Fax:
Practice Address - Street 1:146 MCGEHEE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5012
Practice Address - Country:US
Practice Address - Phone:225-275-7273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor