Provider Demographics
NPI:1649518895
Name:BLACKWELL, ASHLEY ERIN (MA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ERIN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:ERIN
Other - Last Name:DADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1632 PLUME GRASS PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7887
Mailing Address - Country:US
Mailing Address - Phone:512-415-7074
Mailing Address - Fax:
Practice Address - Street 1:3000 JOE DIMAGGIO BLVD STE 88
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3992
Practice Address - Country:US
Practice Address - Phone:512-763-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71524101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional