Provider Demographics
NPI:1215640008
Name:GABLE, KEYIRA
Entity type:Individual
Prefix:MS
First Name:KEYIRA
Middle Name:
Last Name:GABLE
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 1:3100 RIDGELAKE DR STE 309A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4938
Mailing Address - Country:US
Mailing Address - Phone:504-309-0259
Mailing Address - Fax:504-309-2702
Practice Address - Street 1:3100 RIDGELAKE DR STE 309A
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4938
Practice Address - Country:US
Practice Address - Phone:504-309-0259
Practice Address - Fax:504-309-2702
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2023-11-28
Deactivation Date:2023-11-22
Deactivation Code:
Reactivation Date:2023-11-28
Provider Licenses
StateLicense IDTaxonomies
LA00000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1750754727Medicaid