Healthcare Provider Details

I. General information

NPI: 1467098400
Provider Name (Legal Business Name): ASHLEY MARTIN M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S STAPLES ST STE 406
CORPUS CHRISTI TX
78413-2952
US

IV. Provider business mailing address

PO BOX 61160
CORPUS CHRISTI TX
78466-1160
US

V. Phone/Fax

Practice location:
  • Phone: 361-444-5255
  • Fax: 361-998-9698
Mailing address:
  • Phone: 361-884-2904
  • Fax: 361-371-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: