Provider Demographics
NPI:1689928806
Name:KIATOUKAYSI, PA HOUA (LPC)
Entity Type:Individual
Prefix:
First Name:PA HOUA
Middle Name:
Last Name:KIATOUKAYSI
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 1:2270 HOLMGREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4710
Mailing Address - Country:US
Mailing Address - Phone:920-733-2065
Mailing Address - Fax:
Practice Address - Street 1:2270 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4710
Practice Address - Country:US
Practice Address - Phone:920-733-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6036-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional