Healthcare Provider Details

I. General information

NPI: 1750157582
Provider Name (Legal Business Name): ASHLEY MARTIN LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 BALSAM AVE
BATON ROUGE LA
70807
US

IV. Provider business mailing address

7350 JEFFERSON HWY STE 485 PMB 326
BATON ROUGE LA
70806-8278
US

V. Phone/Fax

Practice location:
  • Phone: 225-773-9027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number667962
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6157
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number507577
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: