Provider Demographics
NPI:1053789735
Name:KASEY WITHERINGTON COUNSELING SERVICES
Entity type:Organization
Organization Name:KASEY WITHERINGTON COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:GENTRY
Authorized Official - Last Name:WITHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, COUNSELING
Authorized Official - Phone:318-381-4221
Mailing Address - Street 1:4133 ADELINE LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2175
Mailing Address - Country:US
Mailing Address - Phone:318-381-4221
Mailing Address - Fax:
Practice Address - Street 1:1818 AVENUE OF AMERICA
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4530
Practice Address - Country:US
Practice Address - Phone:318-381-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3816101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty