Healthcare Provider Details

I. General information

NPI: 1568608735
Provider Name (Legal Business Name): COUNCIL FOR THE ADVANCEMENT OF SOCIAL SERVIES AND EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 POLK ST
MANSFIELD LA
71052-2520
US

IV. Provider business mailing address

2120 BERT KOUNS LOOP SUITE E
SHREVEPORT LA
71118-3351
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-1015
  • Fax: 318-872-1055
Mailing address:
  • Phone: 318-688-3350
  • Fax: 318-688-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TIMOTHY SAYLES
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 318-688-3350