Provider Demographics
NPI:1467098400
Name:MARTIN, ASHLEY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3220
Mailing Address - Country:US
Mailing Address - Phone:361-257-9293
Mailing Address - Fax:
Practice Address - Street 1:2714 VANCOUVER DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3220
Practice Address - Country:US
Practice Address - Phone:361-257-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional