Provider Demographics
NPI:1124789144
Name:PHARES, HEATHER ASHLEY (MS, PLPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHLEY
Last Name:PHARES
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FERN AVE STE 1003
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4988
Mailing Address - Country:US
Mailing Address - Phone:318-459-8663
Mailing Address - Fax:
Practice Address - Street 1:7330 FERN AVE STE 1003
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4988
Practice Address - Country:US
Practice Address - Phone:318-459-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2023-07-03
Deactivation Date:2022-01-27
Deactivation Code:
Reactivation Date:2023-07-03
Provider Licenses
StateLicense IDTaxonomies
LAPLC7777101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor