Provider Demographics
NPI:1548771884
Name:COULTER, ASHLEY D (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:COULTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 STONELAKE BLVD APT 366
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6097
Mailing Address - Country:US
Mailing Address - Phone:682-302-1338
Mailing Address - Fax:682-206-3463
Practice Address - Street 1:10011 STONELAKE BLVD APT 366
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6097
Practice Address - Country:US
Practice Address - Phone:682-302-1338
Practice Address - Fax:682-206-3463
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical