Provider Demographics
NPI:1003339540
Name:GOENS, JASON ASA (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ASA
Last Name:GOENS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-6331
Mailing Address - Country:US
Mailing Address - Phone:318-664-8293
Mailing Address - Fax:
Practice Address - Street 1:4606 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3235
Practice Address - Country:US
Practice Address - Phone:318-664-8293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health