=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316446438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEA MICHELE PALAFOX LPC, C. HYP, RTTP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2018
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 W HARWOOD RD APT C
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-3078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-874-4268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 W HARWOOD RD APT C
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-3078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-874-4268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 178.013474
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225600000X
-----------------------------------------------------
Taxonomy Name | Dance Therapist
-----------------------------------------------------
License Number | R-DMT-2200
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 86138
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------