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NPI Code Detail

MEDICARE: ASHLEY NICOLE ANDERSON

MEDICARE: ASHLEY NICOLE ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1124879317
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY NICOLE ANDERSON
Provider Business Mailing Address
First Line : 150 NW TERRE VIEW DR APT I42
Second Line :
City : PULLMAN
State : WA
Zip : 99163-3684
Country : US
Telephone Number : 425-449-0844
Fax Number :
Provider Business Practice Location Address
First Line : 920 6TH ST
Second Line :
City : CLARKSTON
State : WA
Zip : 99403-2079
Country : US
Telephone Number : 509-254-5053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2024
Last Update Date : 03/27/2024

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Directions to “ ASHLEY NICOLE ANDERSON ” Practice Location

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