Provider Demographics
NPI:1811009863
Name:ASHMORE, LYNETTE (MA)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 BROADWAY AVE E
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4610
Mailing Address - Country:US
Mailing Address - Phone:217-238-5700
Mailing Address - Fax:217-238-5767
Practice Address - Street 1:750 BROADWAY AVE E
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4610
Practice Address - Country:US
Practice Address - Phone:217-238-5700
Practice Address - Fax:217-238-5767
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional