Individual
MR. KENNETH ELGIN BEATTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
864 OLIVE ST, SHREVEPORT, LA 71104-2159
(318) 222-0759
(318) 221-0216
Mailing address
6225 DILLINGHAM AVE, SHREVEPORT, LA 71106-3303
(318) 865-4967
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
02/15/2012
Last updated
02/15/2012
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