Provider Demographics
NPI:1821985748
Name:FORMHALS, KAITLYN ALICE (MA, PLPC, PLMFT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALICE
Last Name:FORMHALS
Suffix:
Gender:F
Credentials:MA, PLPC, PLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CEDARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2986
Mailing Address - Country:US
Mailing Address - Phone:406-261-7060
Mailing Address - Fax:
Practice Address - Street 1:1105 HUDSON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6003
Practice Address - Country:US
Practice Address - Phone:318-322-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC10782101YP2500X
LAPLM1596106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional