Individual
ASHLEY JESSICA DIEDRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
609 E HARTFORD AVE, PONCA CITY, OK 74601-2006
(580) 765-0030
(580) 765-0073
Mailing address
118 N 2ND ST STE 200, SAINT CHARLES, MO 63301-2894
(636) 224-1210
(636) 946-0991
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
6314
OK
Other
Enumeration date
05/08/2012
Last updated
03/29/2019
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