MEDICARE: ASHLEY PAYNE ABERNATHY LPC, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11910	TX
2	101Y00000X	Counselor	68005	TX

General Provider Information

NPI Number	:	1881935518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY PAYNE ABERNATHY LPC, LCDC

Provider Business Mailing Address
First Line	:	505 N MORRIS ST
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3645
Country	:	US
Telephone Number	:	469-343-1901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 W HUNT ST BLDG B
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3367
Country	:	US
Telephone Number	:	469-343-1901
Fax Number	:

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

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	11/04/2020

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