Healthcare Provider Details

I. General information

NPI: 1003573601
Provider Name (Legal Business Name): ASHLEY JANZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 WINTERHAWK DR
SAINT AUGUSTINE FL
32086-5576
US

IV. Provider business mailing address

1061 WINTERHAWK DR
SAINT AUGUSTINE FL
32086-5576
US

V. Phone/Fax

Practice location:
  • Phone: 904-377-6312
  • Fax:
Mailing address:
  • Phone: 904-377-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: