Provider Demographics
NPI:1710583471
Name:MOULTON, ASHLEY LEE (M A, LPC, LCDC-I)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LEE
Last Name:MOULTON
Suffix:
Gender:F
Credentials:M A, LPC, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 E CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3309
Mailing Address - Country:US
Mailing Address - Phone:361-576-4673
Mailing Address - Fax:
Practice Address - Street 1:802 E CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3309
Practice Address - Country:US
Practice Address - Phone:361-576-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52248101YA0400X
TX81126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)