Provider Demographics
NPI:1710344775
Name:ASHWORTH, AARON MICHAEL (MA, LPC, CMIII)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:MICHAEL
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:MA, LPC, CMIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 W PHOENIX PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1624
Mailing Address - Country:US
Mailing Address - Phone:918-557-8789
Mailing Address - Fax:
Practice Address - Street 1:8211 E REGAL PL STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7181
Practice Address - Country:US
Practice Address - Phone:918-557-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 171M00000X, 101YM0800X
OK7016405300000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No405300000XOther Service ProvidersPrevention Professional