MEDICARE: ASHLEY LAKELY

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
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1427691534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LAKELY

Provider Business Mailing Address
First Line	:	1885 LUNDY AVE STE 223
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1888
Country	:	US
Telephone Number	:	408-284-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 SAN IGNACIO AVE # 105
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95119-1325
Country	:	US
Telephone Number	:	408-284-9080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	02/22/2021

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Directions to “ ASHLEY LAKELY ” Practice Location

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