Basic Information
Provider Information
NPI: 1952527657
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASHLEY
FirstName: AARON
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9054
Address2:  
City: GRAY
State: TN
PostalCode: 376159054
CountryCode: US
TelephoneNumber: 4234673600
FaxNumber: 4234673644
Practice Location
Address1: 401 HOLSTON DR
Address2:  
City: GREENEVILLE
State: TN
PostalCode: 377433127
CountryCode: US
TelephoneNumber: 4236391104
FaxNumber: 4236368365
Other Information
ProviderEnumerationDate: 04/18/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X  Y Behavioral Health & Social Service ProvidersCounselor 

No ID Information.


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