Provider Demographics
NPI:1063068856
Name:GROVER, KATHY THOMAS
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:THOMAS
Last Name:GROVER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:THOMAS
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RSW
Mailing Address - Street 1:2156 WOODDALE BLVD STE 750
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1404
Mailing Address - Country:US
Mailing Address - Phone:225-930-8058
Mailing Address - Fax:225-930-8059
Practice Address - Street 1:2156 WOODDALE BLVD STE 750
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1404
Practice Address - Country:US
Practice Address - Phone:225-930-8058
Practice Address - Fax:225-930-8059
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8004104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker