Provider Demographics
NPI:1215759345
Name:GUERIN, KEVIN (DOCTOR)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:GUERIN
Suffix:
Gender:M
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14486 N HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-3917
Mailing Address - Country:US
Mailing Address - Phone:225-573-9662
Mailing Address - Fax:
Practice Address - Street 1:14486 N HOLLY ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70819-3917
Practice Address - Country:US
Practice Address - Phone:225-573-9662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAKG789356101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral