Provider Demographics
NPI:1013119924
Name:WALE, ASHLEY R (MHR ,LPC)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:R
Last Name:WALE
Suffix:
Gender:F
Credentials:MHR ,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 S NYSSA AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7685
Mailing Address - Country:US
Mailing Address - Phone:918-813-6684
Mailing Address - Fax:
Practice Address - Street 1:3112 S NYSSA AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7685
Practice Address - Country:US
Practice Address - Phone:918-813-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4622101YM0800X
OK10126171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator