KATHRYN COSTELLO (NPI# 1992225650) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992225650 |
| Entity Type | Individual |
| Full Name | KATHRYN COSTELLO |
| Credential | LPC |
| Practice Address |
3821 Southern Ave Shreveport LA 71106-1033 |
| Mailing Address |
805 Eagles Nest Haughton LA 71037-7721 |
| Practice Telephone | 3189468157 |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | 5571 | LA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 805 Eagles Nest, Haughton, LA 710377721 | 3188052132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447888268 | Kathryn Margaret Costello | Student in an Organized Health Care Education/Training Program | 2835 Hill Rd, Cazenovia, NY 13035-9706 | 2020-03-28 |
| 1043496888 | Kathryn Costello | Developmental Therapist | 602 E Oakton St, Arlington Heights, IL 60004-4905 | 2008-01-10 |
| 1376532887 | Kathryn Costello | Nurse Practitioner | 700 24th St, Fort Lee, VA 23801-1716 | 2005-10-18 |
| Street Address |
3821 SOUTHERN AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71106-1033 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285998716 | Active Recovery LLC | Community/Behavioral Health | 3821 Southern Ave, Active Recovery LLC, Shreveport, LA 71106 | 2012-06-29 |
| 1083239735 | Charles Robert Yates Jr. | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2020-06-09 |
| 1689211047 | Constance Darby | Social Worker | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2019-12-04 |
| 1215570650 | Marshall Turner IIi | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2019-10-17 |
| 1780153270 | Melissa Troy | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2018-11-14 |
| 1093209967 | Robert Francis Conway Jr. | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2018-06-14 |
| 1093204554 | Anna-katrina Keco | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2018-05-09 |
| 1952815458 | Kellye Jean Lewis | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2017-11-21 |
| 1346786373 | Amanda Veuleman | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2017-01-14 |
| 1962865279 | Jeremy Lindsay | Counselor | 3821 Southern Ave, Shreveport, LA 71106-1033 | 2016-04-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972008332 | Andrew Joseph Brouillette | Dentist | 385 Bert Kouns Industrial Loop Ste 700, Shreveport, LA 71106 | 2018-03-28 |
| 1548775885 | David Wayne Spears | Pharmacist | 10460 Norris Ferry Road, Shreveport, LA 71106 | 2017-12-08 |
| 1225559263 | Susan Anderson Roblow | Physical Therapist | 921 Unadilla Street, Shreveport, LA 71106 | 2017-06-29 |
| 1134656382 | James Lowder | Dentist | 8691 Line Ave Ste 300, Shreveport, LA 71106 | 2017-05-18 |
| 1144753708 | Laverne Brantley | Counselor | 328 E 69th St, Shreveport, LA 71106 | 2017-04-10 |
| 1437690849 | Biostat Laboratories, LLC | Clinical Medical Laboratory | 9742 Saint Vincent Ave Ste 200, Shreveport, LA 71106 | 2017-03-17 |
| 1841730728 | Cedric Thomas | Case Manager/Care Coordinator | 6811 Fairfield Avenue, Shreveport, LA 71106 | 2017-02-27 |
| 1225576192 | Nick Vergis | Pharmacist | 5828 Line Avenue, Shreveport, LA 71106 | 2017-02-10 |
| 1184162554 | Marilyn Johnson | Case Manager/Care Coordinator | 9245 Wallace Lake Rd Ste A, Shreveport, LA 71106 | 2017-02-06 |
| 1417499740 | Pamela Lee | Counselor | 8802 Coyth Ln, Shreveport, LA 71106 | 2016-11-17 |
| Find all providers in zip 71106 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962020479 | Whites All Star Consultant | Counselor | 631 E 85th St, Shreveport, LA 71106-5819 | 2020-07-10 |
| 1063046381 | Sharon H Harris | Counselor | 4420 Fairway Dr, Shreveport, LA 71109-4002 | 2020-02-25 |
| 1316422785 | Valencia Sims | Counselor | 6143 Buncombe Rd, Shreveport, LA 71129-4109 | 2018-10-01 |
| 1467954909 | Staughton Jennings | Counselor | 8501 Millicent Way Apt 1085, Shreveport, LA 71115-2231 | 2018-02-28 |
| 1790283638 | Brookys Haven | Counselor | 217 Jones St, Shreveport, LA 71101-4021 | 2018-01-25 |
| 1356859680 | Keshunna Goode | Counselor | 6308 Border Ln, Shreveport, LA 71119-7204 | 2018-01-22 |
| 1407364409 | Kelly Jane Casey | Counselor | 2620 Centenary Blvd Ste 207, Shreveport, LA 71104-3350 | 2018-01-12 |
| 1932619442 | Mark Bolding | Counselor | 8021 Fairfield Ave, Shreveport, LA 71106-5627 | 2017-10-10 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619493830 | Amri A Warren | Counselor | 2403 Helmsdale Ct, Shreveport, LA 71118-4546 | 2017-08-18 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.