Provider Demographics
NPI:1700306438
Name:GREEN, ASHTIN TAYLOR (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ASHTIN
Middle Name:TAYLOR
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ASHTIN
Other - Middle Name:TAYLOR
Other - Last Name:BAXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1751 S 8TH ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1926
Mailing Address - Country:US
Mailing Address - Phone:719-471-1816
Mailing Address - Fax:719-471-9987
Practice Address - Street 1:1751 S 8TH ST BLDG B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1926
Practice Address - Country:US
Practice Address - Phone:719-471-1816
Practice Address - Fax:719-471-9987
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11804101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional