Provider Demographics
NPI:1710355714
Name:WITHERINGTON, KASEY GENTRY (MED,COUNSELING)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:GENTRY
Last Name:WITHERINGTON
Suffix:
Gender:F
Credentials:MED,COUNSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 AVENUE OF AMERICA
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4530
Mailing Address - Country:US
Mailing Address - Phone:318-998-2700
Mailing Address - Fax:
Practice Address - Street 1:4133 ADELINE LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2175
Practice Address - Country:US
Practice Address - Phone:318-381-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3816101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor