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NPI Code Detail

MEDICARE: ASHLEY HENDERSON

MEDICARE: ASHLEY HENDERSON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538666391
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY HENDERSON
Provider Business Mailing Address
First Line : 7330 FERN AVE STE 1102
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-4989
Country : US
Telephone Number : 318-524-9954
Fax Number : 318-524-9954
Provider Business Practice Location Address
First Line : 7330 FERN AVE STE 1102
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-4989
Country : US
Telephone Number : 318-524-9954
Fax Number : 318-524-9954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/09/2018

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Directions to “ ASHLEY HENDERSON ” Practice Location

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