Provider Demographics
NPI:1629562483
Name:MINNITT, ASHLEY RICHARDSON (LCSW-S)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RICHARDSON
Last Name:MINNITT
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 AMISTAD WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1430
Mailing Address - Country:US
Mailing Address - Phone:806-790-0500
Mailing Address - Fax:
Practice Address - Street 1:1713 AMISTAD WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1430
Practice Address - Country:US
Practice Address - Phone:806-790-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical