Provider Demographics
NPI:1386108637
Name:PETTY, ASHLEY R (MS, LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:PETTY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MATHEWS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5726
Mailing Address - Country:US
Mailing Address - Phone:337-519-3496
Mailing Address - Fax:
Practice Address - Street 1:100 COULEE SHORE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3021
Practice Address - Country:US
Practice Address - Phone:337-519-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7714101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor