Provider Demographics
NPI:1053186106
Name:NAGEL, ASHLEY NICOLE (PLPC, CRC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICOLE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:PLPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GRAVOIS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4122
Mailing Address - Country:US
Mailing Address - Phone:314-270-2334
Mailing Address - Fax:
Practice Address - Street 1:320 GRAVOIS RD STE 230
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4122
Practice Address - Country:US
Practice Address - Phone:314-270-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024014789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional