=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497250039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASHLEY AARON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2018
-----------------------------------------------------
Last Update Date | 03/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65-1206 MAMALAHOA HWY STE 2-203
-----------------------------------------------------
City | KAMUELA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96743-8324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-654-8018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1573
-----------------------------------------------------
City | HONOKAA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96727-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-654-8018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | ASHLEY AARON
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 575-654-8018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 492
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------