Provider Demographics
NPI:1700599420
Name:MCCRADY, KATELYN ANN (PLPC)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ANN
Last Name:MCCRADY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 POINT ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4744
Mailing Address - Country:US
Mailing Address - Phone:985-851-4488
Mailing Address - Fax:
Practice Address - Street 1:235 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5937
Practice Address - Country:US
Practice Address - Phone:985-879-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC9704101Y00000X, 101YP2500X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist