Healthcare Provider Details

I. General information

NPI: 1407189855
Provider Name (Legal Business Name): JAYNE ANN ASH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 RACETRACK RD
ARENAS VALLEY NM
88022-9712
US

IV. Provider business mailing address

88 RACETRACK RD
ARENAS VALLEY NM
88022-9712
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-9144
  • Fax:
Mailing address:
  • Phone: 575-534-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0103411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: