Provider Demographics
NPI:1861900342
Name:HEBERT, ASHLEY (IMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:IMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 WINTERSET DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2168
Mailing Address - Country:US
Mailing Address - Phone:863-648-1355
Mailing Address - Fax:
Practice Address - Street 1:301 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4801
Practice Address - Country:US
Practice Address - Phone:863-512-1426
Practice Address - Fax:863-512-1426
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty