Healthcare Provider Details

I. General information

NPI: 1114859642
Provider Name (Legal Business Name): ASHETON MARIE TANAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SOUTHBRIDGE PKWY STE 650
BIRMINGHAM AL
35209-1317
US

IV. Provider business mailing address

4622 SKYLINE RIDGE RD
GARDENDALE AL
35071-2998
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax:
Mailing address:
  • Phone: 205-790-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC05984
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: