Provider Demographics
NPI:1720091812
Name:GUIDRY, KENNETH J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2465
Mailing Address - Country:US
Mailing Address - Phone:985-851-0188
Mailing Address - Fax:985-851-0116
Practice Address - Street 1:1750 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2465
Practice Address - Country:US
Practice Address - Phone:985-851-0188
Practice Address - Fax:985-851-0116
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical