Provider Demographics
NPI:1861270571
Name:BYNUM, ASHLEY (MA, LPC-MHSP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 WATAUGA RD APT 1405
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3876
Mailing Address - Country:US
Mailing Address - Phone:443-534-9987
Mailing Address - Fax:
Practice Address - Street 1:203 GRAY COMMONS CIR STE 110
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-5406
Practice Address - Country:US
Practice Address - Phone:423-467-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000005988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional