Provider Demographics
NPI:1205170586
Name:LAUBE, ASHLEY
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:LAUBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 WEST RAMSEY SUITE 1
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-849-3896
Mailing Address - Fax:951-849-0506
Practice Address - Street 1:2781 W RAMSEY ST STE 1
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3700
Practice Address - Country:US
Practice Address - Phone:951-849-3896
Practice Address - Fax:951-849-0506
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist