Healthcare Provider Details

I. General information

NPI: 1184383721
Provider Name (Legal Business Name): ASHLEY N. ARMENTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST
BRYAN TX
77802-2622
US

IV. Provider business mailing address

528 EDGEVIEW DR
GRAND PRAIRIE TX
75052-3156
US

V. Phone/Fax

Practice location:
  • Phone: 979-436-0700
  • Fax:
Mailing address:
  • Phone: 121-468-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: