Provider Demographics
NPI:1245689348
Name:NEDERVELD, ASHLEY (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NEDERVELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9222
Mailing Address - Country:US
Mailing Address - Phone:616-291-3434
Mailing Address - Fax:
Practice Address - Street 1:4474 2ND ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9222
Practice Address - Country:US
Practice Address - Phone:616-291-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018295101YP2500X
MI6301016727103TC0700X
MI6401015585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional