Provider Demographics
NPI:1336316470
Name:BLACKMAN, KATHY R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:R
Last Name:BLACKMAN
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 1:902 SHANGHAI RD
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3348
Mailing Address - Country:US
Mailing Address - Phone:318-729-0389
Mailing Address - Fax:318-445-6503
Practice Address - Street 1:902 SHANGHAI RD
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3348
Practice Address - Country:US
Practice Address - Phone:318-729-0389
Practice Address - Fax:318-445-6503
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457529349OtherNPI - COMPASSIONATE COUNSELING CENTER, L.L.C.