Provider Demographics
NPI:1760882740
Name:ASHLEY, TARA (LCSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ASHLEY
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 1:21 CRAZY MOUNTAIN VISTA RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-7205
Mailing Address - Country:US
Mailing Address - Phone:406-409-9913
Mailing Address - Fax:
Practice Address - Street 1:21 CRAZY MOUNTAIN VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-7205
Practice Address - Country:US
Practice Address - Phone:406-409-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-502511041C0700X
MN319591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical