Provider Demographics
NPI:1760694616
Name:MACAULAY, KATHRYN MICHELE (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MICHELE
Last Name:MACAULAY
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3918 LE BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006
Mailing Address - Country:US
Mailing Address - Phone:318-965-4803
Mailing Address - Fax:
Practice Address - Street 1:OVERTON BROOKS VA MEDICAL CENTER 510 EAST STONER AVENUE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4295
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3290101YP2500X
LAMFT1043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101YP2500XOtherNPI PROFESSIONAL COUNSELO
LA106H00000XOtherMARRIAGE & FAMILY THERAPI