Provider Demographics
NPI:1922565092
Name:HARMON, ASHLEY (LCSW, LCDC-I)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:LCSW, LCDC-I
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCDC-I
Mailing Address - Street 1:5417 S MOPAC EXPY
Mailing Address - Street 2:418
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-815-5949
Mailing Address - Fax:
Practice Address - Street 1:5417 S MOPAC EXPY
Practice Address - Street 2:418
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-815-5949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX583661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNON INSURANCE