Individual
ASHLEY PROVENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1920 THOMES AVE STE 110, CHEYENNE, WY 82001-3543
(210) 823-3808
Mailing address
1516 E 17TH ST, CHEYENNE, WY 82001-4920
(210) 823-3808
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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