Provider Demographics
NPI:1457529349
Name:KATHY R BLACKMAN
Entity Type:Organization
Organization Name:KATHY R BLACKMAN
Other - Org Name:COMPASSIONATE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-640-0701
Mailing Address - Street 1:902 SHANGHAI RD
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3348
Mailing Address - Country:US
Mailing Address - Phone:318-640-0701
Mailing Address - Fax:318-445-6503
Practice Address - Street 1:902 SHANGHAI RD
Practice Address - Street 2:
Practice Address - City:BALL
Practice Address - State:LA
Practice Address - Zip Code:71405-3348
Practice Address - Country:US
Practice Address - Phone:318-640-0701
Practice Address - Fax:318-445-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA993305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S901Medicare PIN