Healthcare Provider Details

I. General information

NPI: 1801192356
Provider Name (Legal Business Name): ASHLEIGH MARIE GUDGEON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 111E
GLENDALE AZ
85308-8725
US

IV. Provider business mailing address

16742 W MOHAVE ST
GOODYEAR AZ
85338-7369
US

V. Phone/Fax

Practice location:
  • Phone: 480-254-6395
  • Fax:
Mailing address:
  • Phone: 623-570-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: