Basic Information
| Provider Information | |||||||||
| NPI: | 1720655400 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUBLITZ | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3512 CASCADE LOOP APT C | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989021097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052371238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 708 BROADWAY STE 170 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984023778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533486548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2021 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC61065638 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.