Provider Demographics
NPI:1275859530
Name:FRUSHA, CARL EVAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:EVAN
Last Name:FRUSHA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 BETIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7257
Mailing Address - Country:US
Mailing Address - Phone:318-388-1250
Mailing Address - Fax:318-388-0948
Practice Address - Street 1:2913 DESIARD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7207
Practice Address - Country:US
Practice Address - Phone:318-388-1250
Practice Address - Fax:318-388-0948
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional