Provider Demographics
NPI:1982167177
Name:MENARD, ASHLEY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MENARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 FENTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7614
Mailing Address - Country:US
Mailing Address - Phone:314-600-8220
Mailing Address - Fax:
Practice Address - Street 1:1091 FENTON PARK DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7614
Practice Address - Country:US
Practice Address - Phone:314-600-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty