Provider Demographics
NPI:1346066073
Name:LASHLEY, ALEXANDER CHASE (LAC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:CHASE
Last Name:LASHLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 N SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2422
Mailing Address - Country:US
Mailing Address - Phone:501-428-3145
Mailing Address - Fax:
Practice Address - Street 1:1949 N GREEN ACRES RD STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2691
Practice Address - Country:US
Practice Address - Phone:501-428-3145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2411020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health