Provider Demographics
NPI:1336455070
Name:POSITIVE FORCES
Entity type:Organization
Organization Name:POSITIVE FORCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:GENTRY
Authorized Official - Last Name:WITHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MEDCOUNSELING
Authorized Official - Phone:318-330-9728
Mailing Address - Street 1:511 BRES AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5915
Mailing Address - Country:US
Mailing Address - Phone:318-322-0037
Mailing Address - Fax:318-343-1107
Practice Address - Street 1:511 BRES AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5915
Practice Address - Country:US
Practice Address - Phone:318-322-0037
Practice Address - Fax:318-343-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2308251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health