Provider Demographics
NPI:1205000791
Name:ANDERSON, LEE ASHLEY (LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ASHLEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8580
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71148-8580
Mailing Address - Country:US
Mailing Address - Phone:318-631-1122
Mailing Address - Fax:318-866-9622
Practice Address - Street 1:2924 KNIGHT ST BLDG 4
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2413
Practice Address - Country:US
Practice Address - Phone:318-631-1122
Practice Address - Fax:318-866-9622
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2685101YP2500X
LA647106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist