Basic Information
| Provider Information | |||||||||
| NPI: | 1134431547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKASKLE | ||||||||
| FirstName: | AMY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 159 WOODSHIRE LN | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712703292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184508719 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 DEVILLE LN | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712706313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182555753 | ||||||||
| FaxNumber: | 3182424698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5450 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.