Individual
ASHLEY DAWN AMBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
938 EVAN DR, O FALLON, IL 62269-3471
(618) 531-9637
Mailing address
938 EVAN DR, O FALLON, IL 62269-3471
(618) 531-9637
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.010153
IL
101YM0800X
Mental Health Counselor
180.010153
IL
Other
Enumeration date
03/24/2016
Last updated
11/14/2019
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