Provider Demographics
NPI:1215737028
Name:GUILLOT, KIOKA BROUSSARD (LPC)
Entity type:Individual
Prefix:
First Name:KIOKA
Middle Name:BROUSSARD
Last Name:GUILLOT
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23450 EDEN ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-2528
Mailing Address - Country:US
Mailing Address - Phone:337-578-2871
Mailing Address - Fax:
Practice Address - Street 1:23450 EDEN ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2528
Practice Address - Country:US
Practice Address - Phone:337-578-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4767101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor