Provider Demographics
NPI:1497209324
Name:LACOUR, CAROLYN
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:LACOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:LACOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1820 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3517
Mailing Address - Country:US
Mailing Address - Phone:318-213-1080
Mailing Address - Fax:318-584-7185
Practice Address - Street 1:3510 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4512
Practice Address - Country:US
Practice Address - Phone:318-636-4194
Practice Address - Fax:318-636-4196
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1885029101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1885029Medicaid