Healthcare Provider Details

I. General information

NPI: 1649052614
Provider Name (Legal Business Name): OUT OF THE ASH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 BUGGY WHIP RD
BREWSTER MA
02631-1640
US

IV. Provider business mailing address

PO BOX 293
SOUTH DENNIS MA
02660-0293
US

V. Phone/Fax

Practice location:
  • Phone: 508-246-3923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BAIRD
Title or Position: OWNER
Credential: LICSW
Phone: 508-360-3288