Healthcare Provider Details

I. General information

NPI: 1417386905
Provider Name (Legal Business Name): ASHLEY LAUREN LONGLEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MAIN ST UNIT 5
BOWLING GREEN OH
43402-2418
US

IV. Provider business mailing address

102 N MAIN ST UNIT 5
BOWLING GREEN OH
43402-2418
US

V. Phone/Fax

Practice location:
  • Phone: 419-378-5585
  • Fax:
Mailing address:
  • Phone: 419-378-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2303838
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number165927
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: