Provider Demographics
NPI:1457649915
Name:KERLEGON, COURTNEY SUZANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:SUZANNE
Last Name:KERLEGON
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 1:2012 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-2006
Mailing Address - Country:US
Mailing Address - Phone:337-304-2387
Mailing Address - Fax:
Practice Address - Street 1:2012 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-2006
Practice Address - Country:US
Practice Address - Phone:337-304-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional