Provider Demographics
NPI:1912474941
Name:IGLUS, KEYONIA H (LPC)
Entity type:Individual
Prefix:
First Name:KEYONIA
Middle Name:H
Last Name:IGLUS
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 1:204 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-4712
Mailing Address - Country:US
Mailing Address - Phone:469-720-9853
Mailing Address - Fax:
Practice Address - Street 1:221 RUE DE JEAN STE 136
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3283
Practice Address - Country:US
Practice Address - Phone:337-943-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9036101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional