Basic Information
| Provider Information | |||||||||
| NPI: | 1457581282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASHLEY | ||||||||
| FirstName: | ROSIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 820 JORDAN ST | ||||||||
| Address2: | SUITE 475 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711014518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184244271 | ||||||||
| FaxNumber: | 3184248194 | ||||||||
| Practice Location | |||||||||
| Address1: | 856 TEXAS AVE | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186585965 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2009 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1067 | LA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 3312 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1417252230 | 05 | LA | MEDICAID |