| Khonsu, Llc | |
|
3419 Nw Evangeline Trwy Ste A-1 Carencro LA 70520-6241 | |
| (337) 319-1315 | |
| Not Available |
| Full Name | Khonsu, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 3419 Nw Evangeline Trwy Ste A-1, Carencro, Louisiana |
| Authorized Official Name and Position | Amanda Lee Holmes (OWNER) |
| Authorized Official Contact | 3373455390 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Khonsu, Llc 3419 Nw Evangeline Trwy Ste A-1 Carencro LA 70520-6241 Ph: (337) 319-1315 | Khonsu, Llc 3419 Nw Evangeline Trwy Ste A-1 Carencro LA 70520-6241 Ph: (337) 319-1315 |
| NPI Number | 1386142545 |
|---|---|
| Provider Enumeration Date | 01/23/2018 |
| Last Update Date | 01/22/2021 |
| Certification Date | 01/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386142545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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