Provider Demographics
NPI:1093101016
Name:ROTH, ASHLEY NICOLE (LMHC, MHP, NCC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:ROTH
Suffix:
Gender:F
Credentials:LMHC, MHP, NCC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICOLE
Other - Last Name:SYLVESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA, MHP, NCC
Mailing Address - Street 1:1650 S TOPAZ WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4474
Mailing Address - Country:US
Mailing Address - Phone:208-605-7070
Mailing Address - Fax:
Practice Address - Street 1:730 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2045
Practice Address - Country:US
Practice Address - Phone:509-458-7686
Practice Address - Fax:509-458-7611
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60559804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health