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General NPI Number Information
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NPI Number | 1053789735
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Entity Type | Organization
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Legal Business Name | KASEY WITHERINGTON COUNSELING SERVICES
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 1818 AVENUE OF AMERICA
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City | MONROE
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State | LA
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Zip | 71201-4530
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Country | US
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Telephone | 318-381-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 4133 ADELINE LN
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City | MONROE
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State | LA
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Zip | 71201-2175
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Country | US
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Telephone | 318-381-4221
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. KASEY GENTRY WITHERINGTON
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Credential | M.ED., COUNSELING
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Telephone | 318-381-4221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3816
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3816
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License Number State | LA
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