Provider Demographics
NPI:1811691215
Name:KINGSBY, MERSHELL
Entity type:Individual
Prefix:
First Name:MERSHELL
Middle Name:
Last Name:KINGSBY
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 1:325 PIAS DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-2142
Mailing Address - Country:US
Mailing Address - Phone:318-918-3708
Mailing Address - Fax:
Practice Address - Street 1:325 PIAS DAVIS RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2142
Practice Address - Country:US
Practice Address - Phone:318-918-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst