Healthcare Provider Details

I. General information

NPI: 1366317034
Provider Name (Legal Business Name): ASHLEY NICOLE BROWN LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

1990 E LOHMAN AVE
LAS CRUCES NM
88001-3172
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-0680
  • Fax:
Mailing address:
  • Phone: 405-209-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2026-0212
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number36347
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: