Provider Demographics
NPI:1538504337
Name:FUSILIER, KRISTY D (PHD LPC)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:D
Last Name:FUSILIER
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BIRDHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:RAYNE
Mailing Address - State:LA
Mailing Address - Zip Code:70578-8972
Mailing Address - Country:US
Mailing Address - Phone:337-366-0191
Mailing Address - Fax:
Practice Address - Street 1:177 BIRDHAVEN RD
Practice Address - Street 2:
Practice Address - City:RAYNE
Practice Address - State:LA
Practice Address - Zip Code:70578-8972
Practice Address - Country:US
Practice Address - Phone:337-366-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional