Active NPI
Ashley Jessica Diedrich, LPC
- Professional Counselor
- Ponca City, OK
National Provider Identifier
1124387329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6314
- Practice address
- 609 E Hartford Ave
Ponca City, OK 74601-2006 - Phone
- (580) 765-0030
- Fax
- (580) 765-0073
- NPI assigned
- May 8, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Professional Counselor | 101YP2500X | 6314 | OK | Primary |
Addresses
Primary practice location
609 E Hartford Ave
Ponca City, OK 74601-2006
Mailing address
118 N 2ND St Ste 200
Saint Charles, MO 63301-2894
Phone (636) 224-1210
Other names 1
- Ashley Jessica Davis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6314 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Preferred Family Healthcare, Inc. | Past | Accepting new patients | |
| Preferred Family Healthcare, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Ponca City, OK
- NPI 1780062943
-
- Federally Qualified Health Center (FQHC)
- Hannibal, MO
- NPI 1306721709
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1336435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553817600000",
"number": "1124387329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 N 2ND ST STE 200",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633012894",
"telephone_number": "636-224-1210",
"fax_number": "636-946-0991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 E HARTFORD AVE",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746012006",
"telephone_number": "580-765-0030",
"fax_number": "580-765-0073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEDRICH",
"first_name": "ASHLEY",
"middle_name": "JESSICA",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-05-08",
"last_updated": "2019-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OK",
"license": "6314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ASHLEY",
"last_name": "DAVIS",
"middle_name": "JESSICA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ponca City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.