MEDICARE: ASHTON CAMPBELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401015270	MI

General Provider Information

NPI Number	:	1225495765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTON CAMPBELL LPC

Provider Business Mailing Address
First Line	:	4074 PONCA DR SW
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1758
Country	:	US
Telephone Number	:	616-240-9044
Fax Number	:

Provider Business Practice Location Address
First Line	:	2874 PORT SHELDON ST STE E
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-7898
Country	:	US
Telephone Number	:	616-240-9044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	11/08/2022

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