Healthcare Provider Details

I. General information

NPI: 1376128975
Provider Name (Legal Business Name): ASHLEY J. TANZOSH MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FORESTER AVE # 29
WARWICK NY
10990-1129
US

IV. Provider business mailing address

3 FORESTER AVE # 29
WARWICK NY
10990-1129
US

V. Phone/Fax

Practice location:
  • Phone: 470-713-4394
  • Fax:
Mailing address:
  • Phone: 470-713-4394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015999
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013792
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01022600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC5115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: