Provider Demographics
NPI:1902416431
Name:THIBOUTOT, ASHLEY LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:THIBOUTOT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHIRLEY ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-1206
Mailing Address - Country:US
Mailing Address - Phone:508-925-0430
Mailing Address - Fax:774-389-1716
Practice Address - Street 1:4 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-1206
Practice Address - Country:US
Practice Address - Phone:085-925-0430
Practice Address - Fax:774-389-1716
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty