Healthcare Provider Details

I. General information

NPI: 1669704169
Provider Name (Legal Business Name): CATHERINE CORUM ASHBY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 SAN YSIDRO XING
SANTA FE NM
87507-3369
US

IV. Provider business mailing address

1733 SAN YSIDRO CROSSING
SANTA FE NM
87507-5768
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-9541
  • Fax:
Mailing address:
  • Phone: 239-248-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0129061
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: