Provider Demographics
NPI:1245017789
Name:BROCKMAN, ASHLEY (MS, LMHC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 NW 20TH LN APT 208
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-9396
Mailing Address - Country:US
Mailing Address - Phone:641-660-4234
Mailing Address - Fax:
Practice Address - Street 1:1200 SW STATE ST # 2C
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2547
Practice Address - Country:US
Practice Address - Phone:515-954-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty