Healthcare Provider Details

I. General information

NPI: 1215609805
Provider Name (Legal Business Name): ASHLEY MARIE YODER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY MARIE PARKER

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CONCOURS STE 8102
ONTARIO CA
91764-5522
US

IV. Provider business mailing address

1123 12TH AVE RD # 175
NAMPA ID
83686-5738
US

V. Phone/Fax

Practice location:
  • Phone: 909-295-5805
  • Fax:
Mailing address:
  • Phone: 208-703-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number104078
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: