Provider Demographics
NPI:1598534166
Name:RILLING, KELLIE (LPC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:RILLING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 JIMMIE DAVIS HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4557
Mailing Address - Country:US
Mailing Address - Phone:318-523-0875
Mailing Address - Fax:
Practice Address - Street 1:1613 JIMMIE DAVIS HWY STE 200
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4557
Practice Address - Country:US
Practice Address - Phone:318-523-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty