Basic Information
Provider Information
NPI: 1871844779
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASH
FirstName: SHERRY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MA, PLPC, NCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 406 N SPRING ST STE 2
Address2:  
City: PERRYVILLE
State: MO
PostalCode: 637751912
CountryCode: US
TelephoneNumber: 5735478305
FaxNumber: 5736514345
Practice Location
Address1: 402 S SILVER SPRINGS RD
Address2:  
City: CAPE GIRARDEAU
State: MO
PostalCode: 637037536
CountryCode: US
TelephoneNumber: 5733341100
FaxNumber: 5736514345
Other Information
ProviderEnumerationDate: 10/02/2012
LastUpdateDate: 10/02/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X2011021442MOY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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