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General NPI Number Information
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NPI Number | 1447692405
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Entity Type | Individual
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Provider Name | ASHLEY MICHELLE MATHIE B.C.B.A.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 18521 E QUEEN CREEK RD STE 105-627
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5870
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Country | US
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Telephone | 801-380-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 2648 RED SKY WAY
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City | SIERRA VISTA
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State | AZ
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Zip | 85635
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Country | US
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Telephone | 801-380-0754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-13696
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License Number State | AZ
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