1578938312 NPI number — ASHLEY MINTON LPC

Table of content: ASHLEY MINTON LPC (NPI 1578938312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578938312 NPI number — ASHLEY MINTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINTON
Provider First Name:
ASHLEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578938312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 JUMPING BROOK RD
Provider Second Line Business Mailing Address:
BLDG #5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-643-4372
Provider Business Mailing Address Fax Number:
732-643-4376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 ROUTE 35 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-643-4400
Provider Business Practice Location Address Fax Number:
732-643-4376
Provider Enumeration Date:
12/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC00535300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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