Provider Demographics
NPI:1689991838
Name:CORLEY, KASHON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KASHON
Middle Name:
Last Name:CORLEY
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:PO BOX 45703
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-4703
Mailing Address - Country:US
Mailing Address - Phone:225-636-1708
Mailing Address - Fax:225-930-4944
Practice Address - Street 1:2435 DRUSILLA LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-364-2090
Practice Address - Fax:225-208-1301
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600746771Medicaid