Healthcare Provider Details

I. General information

NPI: 1174479661
Provider Name (Legal Business Name): ASHLEY AYCOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E THOMAS RD STE 2200
PHOENIX AZ
85012-3133
US

IV. Provider business mailing address

20 E THOMAS RD STE 2200
PHOENIX AZ
85012-3133
US

V. Phone/Fax

Practice location:
  • Phone: 602-705-6855
  • Fax:
Mailing address:
  • Phone: 602-705-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-22488
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: