Healthcare Provider Details

I. General information

NPI: 1528494523
Provider Name (Legal Business Name): MR. ASHLEY MORGAN LENGYEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 HARRIS ST
FERNDALE MI
48220-3423
US

IV. Provider business mailing address

3307 HARRIS ST
FERNDALE MI
48220-3423
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-4719
  • Fax:
Mailing address:
  • Phone: 770-910-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: