Provider Demographics
NPI:1134590409
Name:MARSOLAN, KIM (LPC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MARSOLAN
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 1:600 MARINERS PLAZA DR
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6822
Mailing Address - Country:US
Mailing Address - Phone:985-465-4250
Mailing Address - Fax:866-497-7848
Practice Address - Street 1:600 MARINERS PLAZA DR
Practice Address - Street 2:SUITE 603
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-6822
Practice Address - Country:US
Practice Address - Phone:985-465-4250
Practice Address - Fax:866-497-7848
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6215101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600723292Medicaid