Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003337106 |
---|---|
Provider Name | Miss Kenyell Shantae Mclean |
First Address | Baton Rouge, LA 70806-4804 |
Second Address | Baton Rouge, LA 70806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 29/06/2017 |