Provider Demographics
NPI:1770226953
Name:LAVINE, ASHLYN R
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:R
Last Name:LAVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 TIMBER CREEK DR APT G1
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3061
Mailing Address - Country:US
Mailing Address - Phone:970-235-0412
Mailing Address - Fax:
Practice Address - Street 1:2120 TIMBER CREEK DR APT G1
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3061
Practice Address - Country:US
Practice Address - Phone:970-685-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist