Provider Demographics
NPI:1447657044
Name:WAGLE, ASHLEY (LPCC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WAGLE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 LEWIS STREET,
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147
Mailing Address - Country:US
Mailing Address - Phone:970-264-2104
Mailing Address - Fax:970-264-2108
Practice Address - Street 1:475 LEWIS STREET,
Practice Address - Street 2:SUITE 104
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-264-2104
Practice Address - Fax:970-264-2108
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health