Provider Demographics
NPI:1760694616
Name:MACAULAY, KATHRYN MICHELE (LMFT, LPC,NCC,CCMHC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:MICHELE
Last Name:MACAULAY
Suffix:
Gender:F
Credentials:LMFT, LPC,NCC,CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E STONER AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4243
Mailing Address - Country:US
Mailing Address - Phone:318-221-8411
Mailing Address - Fax:
Practice Address - Street 1:OVERTON BROOKS VA MEDICAL CENTER 510 EAST STONER AVENUE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4295
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3290101YP2500X
LAMFT1043106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA106H00000XOtherMARRIAGE & FAMILY THERAPI
LA101YP2500XOtherNPI PROFESSIONAL COUNSELO