Provider Demographics
NPI:1174086243
Name:COSBY, ASHLEY (ATR, LCPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:ATR, LCPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 S MATTIS AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5923
Practice Address - Country:US
Practice Address - Phone:217-383-1850
Practice Address - Fax:217-383-3439
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178012543101YP2500X
IL180012274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional