Provider Demographics
NPI:1801541032
Name:KITTERLIN, KARLY
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:KITTERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4994
Mailing Address - Country:US
Mailing Address - Phone:318-229-3580
Mailing Address - Fax:
Practice Address - Street 1:7932 SUMMA AVE STE B2
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3736
Practice Address - Country:US
Practice Address - Phone:225-349-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician