Provider Demographics
NPI:1861845422
Name:KINZY, CARMEN (LPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:KINZY
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 406
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-0406
Mailing Address - Country:US
Mailing Address - Phone:985-514-1470
Mailing Address - Fax:985-509-8853
Practice Address - Street 1:72476 BRIDGEMORE RD
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-8504
Practice Address - Country:US
Practice Address - Phone:985-514-1470
Practice Address - Fax:985-509-8853
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional