Provider Demographics
NPI:1649913500
Name:ASHBURN, CODY LEE (MS LPCC)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:ASHBURN
Suffix:
Gender:M
Credentials:MS LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10909 NOBLE AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3509
Mailing Address - Country:US
Mailing Address - Phone:320-293-3238
Mailing Address - Fax:
Practice Address - Street 1:2006 1ST AVE STE 201
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2255
Practice Address - Country:US
Practice Address - Phone:320-293-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health