MEDICARE: COUNSELING, CONSULTATION AND ASSESSMENT RESOURCES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3513	LA

General Provider Information

NPI Number	:	1467963660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING, CONSULTATION AND ASSESSMENT RESOURCES, LLC

Provider Business Mailing Address
First Line	:	15525 PINEWOOD DR
Second Line	:
City	:	PRIDE
State	:	LA
Zip	:	70770-9637
Country	:	US
Telephone Number	:	225-305-3540
Fax Number	:

Provider Business Practice Location Address
First Line	:	12090 S HARRELLS FERRY RD STE M
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2470
Country	:	US
Telephone Number	:	225-305-3540
Fax Number	:	225-262-4822

Authorized Official
Title or Position	:	MANGER MEMBER
Name	:	MRS. ANN K PHILLIPS
Credential	:	LCSW
Telephone Number	:	225-305-3540

Provider Enumeration Date	:	10/16/2017
Last Update Date	:	10/16/2017

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