MEDICARE: ASHLEY MICHELE STAVIG LMHC

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
1	101YM0800X	Mental Health Counselor	001473	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12507516	OTHER	IA	CAQH

General Provider Information

NPI Number	:	1316204704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MICHELE STAVIG LMHC

Provider Business Mailing Address
First Line	:	2106 40TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50310-3841
Country	:	US
Telephone Number	:	515-360-6199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 VALLEY WEST DR STE 302
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1904
Country	:	US
Telephone Number	:	515-267-1340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/09/2014

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