Provider Demographics
NPI:1306476031
Name:LAIZURE, ASHLEY VANESSA (NCPT1)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:VANESSA
Last Name:LAIZURE
Suffix:
Gender:F
Credentials:NCPT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 N CLARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9581
Mailing Address - Country:US
Mailing Address - Phone:208-625-9170
Mailing Address - Fax:
Practice Address - Street 1:221 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3704
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2022-080167G00000X
IDRBT-20-114353106S00000X
WACG61427270101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician