Provider Demographics
NPI:1013688084
Name:PFLIPSEN, KATHRYN (LAC, CCS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PFLIPSEN
Suffix:
Gender:F
Credentials:LAC, CCS
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:R
Other - Last Name:PFLIPSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, CCS
Mailing Address - Street 1:920 TWIN BRIDGES RD APT 47
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2071
Mailing Address - Country:US
Mailing Address - Phone:318-452-4526
Mailing Address - Fax:
Practice Address - Street 1:2116 N BOLTON AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4405
Practice Address - Country:US
Practice Address - Phone:318-445-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1811543838261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA18811543838Medicaid