Kristal Butler Poland, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPC6466 Issued in LA

Practice address

458 Herndon St
Shreveport, LA 71101-4859

Phone

(318) 213-1860

Fax

(318) 213-1818

NPI assigned

Oct 4, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Volunteers of America of North Louisiana

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Shreveport, LA
  • NPI 1417252230
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1295245215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9434 CROOKED CREEK DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711184155",
            "telephone_number": "318-332-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 HERNDON ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014859",
            "telephone_number": "318-213-1860",
            "fax_number": "318-213-1818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2715 Mackey Pl Ste 135",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711182528",
            "country_code": "US",
            "telephone_number": "318-220-8423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLAND",
        "first_name": "KRISTAL",
        "middle_name": "BUTLER",
        "name_prefix": "Mrs.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-04",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "LA",
            "license": "LPC6466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VOLUNTEERS OF AMERICA NORTH LOUISIANA",
            "identifier": "1417252230",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Raven Danyale Ponds

• Mental Health Counselor in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Mental Health Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.