Provider Demographics
NPI:1104431840
Name:HALL, KAITLYN JACKSON (MA LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JACKSON
Last Name:HALL
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11418 ASHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6492
Mailing Address - Country:US
Mailing Address - Phone:225-281-9658
Mailing Address - Fax:
Practice Address - Street 1:1325 WRIGHT AVE STE D
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-514-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA8704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator