Provider Demographics
NPI:1790119873
Name:PICKARD, ASHLEY SUZANNE (LMFT, PMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUZANNE
Last Name:PICKARD
Suffix:
Gender:F
Credentials:LMFT, PMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 JOHN KNOX ROAD
Mailing Address - Street 2:BLDG. T, SUITE 1
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4543
Mailing Address - Country:US
Mailing Address - Phone:408-482-0188
Mailing Address - Fax:408-482-0188
Practice Address - Street 1:325 JOHN KNOX ROAD
Practice Address - Street 2:BLDG. T, SUITE 1
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:916-234-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111985106H00000X
CAIMF82382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPMT-259OtherPROVISIONAL MARRIAGE AND FAMILY THERAPIST LICENSEE