Healthcare Provider Details

I. General information

NPI: 1982167177
Provider Name (Legal Business Name): ASHLEY MENARD MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 FENTON PARK DR
FENTON MO
63026-7614
US

IV. Provider business mailing address

1091 FENTON PARK DR
FENTON MO
63026-7614
US

V. Phone/Fax

Practice location:
  • Phone: 314-600-8220
  • Fax:
Mailing address:
  • Phone: 314-600-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2016019096
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: