Provider Demographics
NPI:1275874851
Name:JACKSON, ASHLEY N (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MCCLENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2036
Mailing Address - Country:US
Mailing Address - Phone:317-338-4600
Mailing Address - Fax:
Practice Address - Street 1:8401 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2036
Practice Address - Country:US
Practice Address - Phone:317-338-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003685A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health