Provider Demographics
NPI:1760028096
Name:AUDIRSCH, CASEY NICHOLAS (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:NICHOLAS
Last Name:AUDIRSCH
Suffix:
Gender:M
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 TECH FARM RD APT D2
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5464
Mailing Address - Country:US
Mailing Address - Phone:318-918-8213
Mailing Address - Fax:
Practice Address - Street 1:829 E GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3912
Practice Address - Country:US
Practice Address - Phone:318-242-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator