Healthcare Provider Details

I. General information

NPI: 1326512765
Provider Name (Legal Business Name): ASHLEY KOBER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDER ST
JONESBORO LA
71251-2001
US

IV. Provider business mailing address

3625 YOUREE DR
SHREVEPORT LA
71105-2121
US

V. Phone/Fax

Practice location:
  • Phone: 318-259-4676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7776
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: