Healthcare Provider Details

I. General information

NPI: 1184102238
Provider Name (Legal Business Name): ASHLEY JEAN PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 RIDGEWOOD RD
WILLITS CA
95490-9787
US

IV. Provider business mailing address

3575 RIDGEWOOD RD
WILLITS CA
95490-9787
US

V. Phone/Fax

Practice location:
  • Phone: 707-972-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: