Provider Demographics
NPI:1376739565
Name:POWELL, KATHY G (LCSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3212
Mailing Address - Country:US
Mailing Address - Phone:318-345-8068
Mailing Address - Fax:318-345-8068
Practice Address - Street 1:6420 CYPRESS POINT DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3212
Practice Address - Country:US
Practice Address - Phone:318-345-8068
Practice Address - Fax:318-345-8068
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical