Provider Demographics
NPI:1114352481
Name:GOLLY, ASHLEY CAROL (LMHC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CAROL
Last Name:GOLLY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-602-9833
Mailing Address - Fax:319-343-1161
Practice Address - Street 1:700 2ND ST SE STE 101
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50441-2658
Practice Address - Country:US
Practice Address - Phone:641-812-1094
Practice Address - Fax:641-812-1096
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IA001702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)