Provider Demographics
NPI:1285372656
Name:HARPER, KELLY EATON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:EATON
Last Name:HARPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8386
Mailing Address - Country:US
Mailing Address - Phone:318-267-0901
Mailing Address - Fax:
Practice Address - Street 1:6498 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-8386
Practice Address - Country:US
Practice Address - Phone:318-267-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA57221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty