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NPI Code Detail

MEDICARE: ASHLEY MASTER TLLP

MEDICARE: ASHLEY MASTER TLLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6362010205MI
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1033954250
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY MASTER TLLP
Provider Business Mailing Address
First Line : 300 68TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49548-6927
Country : US
Telephone Number : 616-455-5000
Fax Number :
Provider Business Practice Location Address
First Line : 700 E HAMMOND RD STE 200
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-8641
Country : US
Telephone Number : 231-947-2255
Fax Number : 231-947-5982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2024
Last Update Date : 06/24/2026

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Directions to “ ASHLEY MASTER TLLP” Practice Location

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