Provider Demographics
NPI:1831484534
Name:GAY, KELLY KATHRYN (LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:KATHRYN
Last Name:GAY
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 1:2924 KNIGHT ST
Mailing Address - Street 2:STE. 434
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2415
Mailing Address - Country:US
Mailing Address - Phone:318-631-1122
Mailing Address - Fax:318-866-9622
Practice Address - Street 1:2924 KNIGHT ST
Practice Address - Street 2:STE. 434
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2415
Practice Address - Country:US
Practice Address - Phone:318-631-1122
Practice Address - Fax:318-866-9622
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional