Healthcare Provider Details

I. General information

NPI: 1003936170
Provider Name (Legal Business Name): ASHLEY L SOUTHARD PH.D., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 N 95TH ST SUITE 101
SCOTTSDALE AZ
85258-4590
US

IV. Provider business mailing address

9825 N 95TH ST SUITE 101
SCOTTSDALE AZ
85258-4590
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-4247
  • Fax: 480-941-4010
Mailing address:
  • Phone: 480-941-4247
  • Fax: 480-941-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: