=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578231718
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY HALLETT LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 08/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14000 NORTHDALE BLVD STE 1
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55374-4662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-998-9619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 E FLYNN ST
-----------------------------------------------------
City | REDWOOD FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56283-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-696-4198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2928
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------