Provider Demographics
NPI:1215445556
Name:CARR, ASHLEY L (MA, QMHP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:CARR
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:L
Other - Last Name:BERROCAL LLERENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1879 11TH PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2687
Mailing Address - Country:US
Mailing Address - Phone:541-501-5207
Mailing Address - Fax:
Practice Address - Street 1:1695 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4063
Practice Address - Country:US
Practice Address - Phone:541-264-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X, 101Y00000X, 101YM0800X
ORR7896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5000767629Medicaid