Healthcare Provider Details

I. General information

NPI: 1124789144
Provider Name (Legal Business Name): HEATHER ASHLEY PHARES MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date: 01/27/2022
Reactivation Date: 07/03/2023

III. Provider practice location address

7330 FERN AVE STE 801
SHREVEPORT LA
71105-4986
US

IV. Provider business mailing address

7330 FERN AVE STE 801
SHREVEPORT LA
71105-4986
US

V. Phone/Fax

Practice location:
  • Phone: 318-459-8663
  • Fax:
Mailing address:
  • Phone: 318-459-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC7777
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: