Provider Demographics
NPI:1235605668
Name:COLVILLE, ASHLEE BROOKE (LPCA)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:BROOKE
Last Name:COLVILLE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1037
Mailing Address - Country:US
Mailing Address - Phone:502-612-9129
Mailing Address - Fax:
Practice Address - Street 1:13121 ESAT POINT PARK BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-612-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY244758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health