Provider Demographics
NPI:1619590916
Name:PARK, ASHLEY (MA, LPCC, ATR-P)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MA, LPCC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 RIVER VIEW CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8652
Mailing Address - Country:US
Mailing Address - Phone:217-891-5338
Mailing Address - Fax:
Practice Address - Street 1:420 E 58TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-1400
Practice Address - Country:US
Practice Address - Phone:720-854-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COATR-P19-532221700000X
COLPCC.0017243101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty