Provider Demographics
NPI:1124480058
Name:VYAS, ASHA MARIE (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:MARIE
Last Name:VYAS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 LAKE BEAU PRE BLVD APT 66
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820
Mailing Address - Country:US
Mailing Address - Phone:225-715-5800
Mailing Address - Fax:
Practice Address - Street 1:4000 LAKE BEAU PRE BLVD APT 66
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820
Practice Address - Country:US
Practice Address - Phone:225-715-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional