Active NPI
Ashlyn Blaine Gautam, LPC
- Professional Counselor
- Columbia, MO
National Provider Identifier
1346033735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2019030961
- Practice address
- 2800 Forum Blvd Ste 4a
Columbia, MO 65203-5468 - Phone
- (573) 542-0578
- NPI assigned
- May 28, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2019030961 | MO | Primary |
Addresses
Primary practice location
2800 Forum Blvd Ste 4a
Columbia, MO 65203-5468
Mailing address
2800 Forum Blvd Ste 4a
Columbia, MO 65203-5468
Phone (573) 542-0578
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 |
|---|---|---|---|
| 2019030961 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748390400000",
"number": "1346033735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2800 FORUM BLVD STE 4A",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652035468",
"telephone_number": "573-542-0578"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 FORUM BLVD STE 4A",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652035468",
"telephone_number": "573-542-0578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUTAM",
"first_name": "ASHLYN",
"middle_name": "BLAINE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-05-28",
"last_updated": "2025-05-28",
"certification_date": "2025-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2019030961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.