Provider Demographics
NPI:1508155649
Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Entity Type:Organization
Organization Name:COUNCIL FOR ADVANCEMENT OF SOCIAL SERVICE AND EDUCATION
Other - Org Name:CASSE/DENTAL HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-688-3350
Mailing Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3351
Mailing Address - Country:US
Mailing Address - Phone:318-688-3350
Mailing Address - Fax:318-688-3655
Practice Address - Street 1:2120 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:SUITE E
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3351
Practice Address - Country:US
Practice Address - Phone:318-688-3350
Practice Address - Fax:318-688-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty