Healthcare Provider Details

I. General information

NPI: 1629569611
Provider Name (Legal Business Name): ASHLEY CAUDELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 BAHNS MILL RD
RED LION PA
17356-8515
US

IV. Provider business mailing address

1155 BAHNS MILL RD
RED LION PA
17356-8515
US

V. Phone/Fax

Practice location:
  • Phone: 812-890-3327
  • Fax:
Mailing address:
  • Phone: 812-890-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001515
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: