Provider Demographics
NPI:1003459660
Name:SMITH, ASHLEY BROOK (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:BROOK
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 N C 470
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538-6154
Mailing Address - Country:US
Mailing Address - Phone:719-344-1503
Mailing Address - Fax:
Practice Address - Street 1:1924 N C 470
Practice Address - Street 2:
Practice Address - City:LAKE PANASOFFKEE
Practice Address - State:FL
Practice Address - Zip Code:33538-6154
Practice Address - Country:US
Practice Address - Phone:719-344-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21519101YM0800X
FLIMH19446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health