Basic Information
Provider Information
NPI: 1275918625
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREECE
FirstName: ASHLEY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1326
Address2:  
City: MARSHALL
State: TX
PostalCode: 756711326
CountryCode: US
TelephoneNumber: 9039273782
FaxNumber: 9039271764
Practice Location
Address1: 4077 JEFFERSON AVE
Address2:  
City: TEXARKANA
State: AR
PostalCode: 718541509
CountryCode: US
TelephoneNumber: 8703309200
FaxNumber: 8703309439
Other Information
ProviderEnumerationDate: 07/28/2015
LastUpdateDate: 07/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XP1712387ARY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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