Provider Demographics
NPI:1720416670
Name:MOORE, ASHLEY PEYTON (LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PEYTON
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 STONERIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-778-5060
Mailing Address - Fax:541-843-2991
Practice Address - Street 1:1605 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-778-1984
Practice Address - Fax:541-843-2991
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7645101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500739019Medicaid