Healthcare Provider Details

I. General information

NPI: 1407238025
Provider Name (Legal Business Name): ASHLEY MARIE BEWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BERTRAM

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

IV. Provider business mailing address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

V. Phone/Fax

Practice location:
  • Phone: 616-443-1906
  • Fax:
Mailing address:
  • Phone: 989-488-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: