Basic Information
| Provider Information | |||||||||
| NPI: | 1457529349 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KATHY R BLACKMAN | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COMPASSIONATE COUNSELING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 902 SHANGHAI RD | ||||||||
| Address2: | |||||||||
| City: | BALL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714053348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186400701 | ||||||||
| FaxNumber: | 3184456503 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 SHANGHAI RD | ||||||||
| Address2: | |||||||||
| City: | BALL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714053348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186400701 | ||||||||
| FaxNumber: | 3184456503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BLACKMAN | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3186400701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | L.C.S.W. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | 993 | LA | Y | Managed Care Organizations | Point of Service |
No ID Information.