Provider Demographics
NPI:1104145507
Name:FANGUY, KAYLA S (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:S
Last Name:FANGUY
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:BLDG. D, SUITE B-220
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6928
Mailing Address - Country:US
Mailing Address - Phone:337-981-2180
Mailing Address - Fax:337-981-2391
Practice Address - Street 1:4540 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BLDG. D, SUITE B-220
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6928
Practice Address - Country:US
Practice Address - Phone:337-981-2180
Practice Address - Fax:337-981-2391
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3986101Y00000X
LA1129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor