Provider Demographics
NPI:1700563442
Name:LASHLEY, DYLAN (MHC-LP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24520 GRAND CENTRAL PKWY APT 2M
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2710
Mailing Address - Country:US
Mailing Address - Phone:516-761-0596
Mailing Address - Fax:
Practice Address - Street 1:25010 GRAND CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2738
Practice Address - Country:US
Practice Address - Phone:516-761-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP119947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health