Provider Demographics
NPI:1154993095
Name:EDUCATIONAL ADVOCACY SUPPORTS & ENTERPRISES, LLC
Entity type:Organization
Organization Name:EDUCATIONAL ADVOCACY SUPPORTS & ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SP. IN SCHOOL PSYCHOLOGY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASSELS
Authorized Official - Suffix:
Authorized Official - Credentials:NCSP, LSSP
Authorized Official - Phone:318-363-0211
Mailing Address - Street 1:P O BOX 395
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:LA
Mailing Address - Zip Code:71225
Mailing Address - Country:US
Mailing Address - Phone:318-363-0211
Mailing Address - Fax:
Practice Address - Street 1:2106 LOOP RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3344
Practice Address - Country:US
Practice Address - Phone:318-435-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty