Healthcare Provider Details

I. General information

NPI: 1265142889
Provider Name (Legal Business Name): ASHTON JOHNSON QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 W CENTRAL AVE STE B
TOLEDO OH
43606-2945
US

IV. Provider business mailing address

3170 W CENTRAL AVE STE B
TOLEDO OH
43606-2945
US

V. Phone/Fax

Practice location:
  • Phone: 567-316-7253
  • Fax:
Mailing address:
  • Phone: 567-316-7253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: