Provider Demographics
NPI:1295245215
Name:POLAND, KRISTAL BUTLER (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:BUTLER
Last Name:POLAND
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 1:9434 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-4155
Mailing Address - Country:US
Mailing Address - Phone:318-332-2187
Mailing Address - Fax:
Practice Address - Street 1:458 HERNDON ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4859
Practice Address - Country:US
Practice Address - Phone:318-213-1860
Practice Address - Fax:318-213-1818
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC6466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1417252230OtherVOLUNTEERS OF AMERICA NORTH LOUISIANA