Healthcare Provider Details

I. General information

NPI: 1275859530
Provider Name (Legal Business Name): CARL EVAN FRUSHA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 DESIARD ST
MONROE LA
71201-7207
US

IV. Provider business mailing address

2913 BETIN AVE
MONROE LA
71201-7257
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-1250
  • Fax: 318-388-0948
Mailing address:
  • Phone: 318-388-1250
  • Fax: 318-388-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2192
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: