Ashley Dawn Amburn, LCPC
Individual provider Active NPI Counselor · O Fallon, IL
NPI 1043672512 · NPPES record last updated Nov 14, 2019
Key facts
- NPI
- 1043672512
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 180.010153 (IL)
- Practice address
- 938 Evan Dr
O Fallon, IL 62269-3471 - Phone
- (618) 531-9637
- NPI assigned
- Mar 24, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250605002700 | IL | Practitioner - Clinical Social Worker | 4688935877 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.010153 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoyleton Youth and Family Services | Current |
Accepting new patients |
Locations
8 Executive Dr
Ste 200
Fairview Hts, IL 62208
Phone (618) 688-4727
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 180.010153 | IL | |
| Counselor | 101Y00000X | 180.010153 | IL | Yes |
Addresses
Primary practice location
938 Evan Dr
O Fallon, IL 62269-3471
Mailing address
938 Evan Dr
O Fallon, IL 62269-3471
Phone (618) 531-9637
Other providers in O Fallon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.