Basic Information
| Provider Information | |||||||||
| NPI: | 1922405109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASRCOUNSELINGSERVICESLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 HICKORY AVE | ||||||||
| Address2: | STE.11 | ||||||||
| City: | HARAHAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701234068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043198028 | ||||||||
| FaxNumber: | 5043094845 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 WALL BLVD | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700567725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043198028 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
| AuthorizedOfficialMiddleName: | SMITH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5043198028 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5149 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.