=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346013364
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHTON MCMILLEN LMFT, LPC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2023
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | THE MADE WELL HOUSE 107 S PRESTON AVE.
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-428-4663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2099 POSITANO LOOP
-----------------------------------------------------
City | BRYAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77808-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-480-2626
-----------------------------------------------------
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 | 87754
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 203443
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------