Healthcare Provider Details

I. General information

NPI: 1023365616
Provider Name (Legal Business Name): ASHLEY L MAURER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26522 VAN DYKE AVE
CENTER LINE MI
48015-1221
US

IV. Provider business mailing address

6549 TOWN CENTER DR SUITE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-4400
  • Fax: 586-759-4401
Mailing address:
  • Phone: 248-620-6400
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: