Provider Demographics
NPI:1376026880
Name:KING, KELLI (LPC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 HOLLOW WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7723
Mailing Address - Country:US
Mailing Address - Phone:318-464-4594
Mailing Address - Fax:
Practice Address - Street 1:2105 HOLLOW WOOD WAY
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-7723
Practice Address - Country:US
Practice Address - Phone:184-644-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional