Provider Demographics
NPI:1437868940
Name:ASHLEY DOERGE
Entity type:Organization
Organization Name:ASHLEY DOERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC
Authorized Official - Phone:618-598-6040
Mailing Address - Street 1:11233 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-3027
Mailing Address - Country:US
Mailing Address - Phone:618-598-6040
Mailing Address - Fax:618-615-4151
Practice Address - Street 1:11233 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-3027
Practice Address - Country:US
Practice Address - Phone:618-598-6040
Practice Address - Fax:618-615-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty