Individual
ZURI POULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1639 RYAN ST, LAKE CHARLES, LA 70601-5948
(337) 602-6391
(337) 602-6392
Mailing address
1639 RYAN ST, LAKE CHARLES, LA 70601-5948
(337) 602-6391
(337) 602-6392
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2203783030
KINGDOM EXPRESSIONS LLC BEHAVIORAL HEALTH- MHS
LA
Enumeration date
04/26/2017
Last updated
04/26/2017
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