Provider Demographics
NPI:1942381249
Name:MAYEAUX, KATHRYN KELLER (LPC LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KELLER
Last Name:MAYEAUX
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 PIERREMONT RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2056
Mailing Address - Country:US
Mailing Address - Phone:318-861-8401
Mailing Address - Fax:318-861-8402
Practice Address - Street 1:910 PIERREMONT RD
Practice Address - Street 2:SUITE 410
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2056
Practice Address - Country:US
Practice Address - Phone:318-861-8401
Practice Address - Fax:318-861-8402
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2123101YM0800X
LA785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist