Basic Information
| Provider Information | |||||||||
| NPI: | 1477162527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TARRENCE | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | I | ||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2645 BEAVER DAM RD | ||||||||
| Address2: | |||||||||
| City: | LEITCHFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427549053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708992257 | ||||||||
| FaxNumber: | 8558591695 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 MILLERSTOWN ST | ||||||||
| Address2: | |||||||||
| City: | CLARKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427268146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708992257 | ||||||||
| FaxNumber: | 8558591695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2020 | ||||||||
| LastUpdateDate: | 08/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.