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General NPI Number Information
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NPI Number | 1851809099
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Entity Type | Organization
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Legal Business Name | BRIAN ASHLEY, MA, PLC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 100 MAIN ST OFC 14
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City | BURLINGTON
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State | VT
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Zip | 05401-8475
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Country | US
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Telephone | 802-989-6839
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Fax |
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Provider Business Mailing Address
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Address Line | 409 LAWNWOOD DR
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City | WILLISTON
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State | VT
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Zip | 05495-5227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN ASHLEY
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Credential |
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Telephone | 802-989-6839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 047.0111342
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License Number State | VT
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