Provider Demographics
NPI:1457877391
Name:ASHMORE, GUY BRENT (LCSW)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:BRENT
Last Name:ASHMORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6787 W TROPICANA AVE STE 253
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4759
Mailing Address - Country:US
Mailing Address - Phone:702-719-9609
Mailing Address - Fax:
Practice Address - Street 1:6787 W TROPICANA AVE STE 253
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4759
Practice Address - Country:US
Practice Address - Phone:702-719-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7119-S104100000X
NVIC-12431041C0700X
NV9759-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9759-COtherLICENSED CLINICAL SOCIAL WORKER
NV250013402Medicaid