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General NPI Number Information
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NPI Number | 1972057610
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Entity Type | Individual
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Provider Name | ASHLEY BASCOME LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 4200 N UNIVERSITY DR
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City | SUNRISE
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State | FL
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Zip | 33351-6210
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Country | US
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Telephone | 954-494-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 6251 WINDCHIME PL
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City | BOYNTON BEACH
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State | FL
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Zip | 33472-5116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH13930
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License Number State | FL
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