=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225185499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA LASTER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 09/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 LEE AVE
-----------------------------------------------------
City | EARLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-792-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 703 CALVIN AVERY DR
-----------------------------------------------------
City | WEST MEMPHIS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72301-6501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-732-1878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 1728
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------