Provider Demographics
NPI:1346989506
Name:EMMONS, ASHLEY B (LMSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:B
Last Name:EMMONS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5932
Mailing Address - Country:US
Mailing Address - Phone:575-769-4300
Mailing Address - Fax:575-769-4333
Practice Address - Street 1:1009 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5932
Practice Address - Country:US
Practice Address - Phone:575-769-4300
Practice Address - Fax:575-769-4333
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NMSWB-2023-13331041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator