Provider Demographics
NPI:1093589012
Name:ASHURST, JUSTIN NICHOLAS (MA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:NICHOLAS
Last Name:ASHURST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 ANDOVER CAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-2702
Mailing Address - Country:US
Mailing Address - Phone:407-583-7550
Mailing Address - Fax:
Practice Address - Street 1:3361 ROUSE RD STE 215
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2137
Practice Address - Country:US
Practice Address - Phone:407-583-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
FLMH19095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral