Provider Demographics
NPI:1720895808
Name:ZYLICZ, KATIE (LPC-S)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:ZYLICZ
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 S POLLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-7805
Mailing Address - Country:US
Mailing Address - Phone:225-505-9215
Mailing Address - Fax:
Practice Address - Street 1:668 S FOSTER DR STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5945
Practice Address - Country:US
Practice Address - Phone:225-505-9215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health