Provider Demographics
NPI:1003936170
Name:SOUTHARD, ASHLEY L (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:L
Last Name:SOUTHARD
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 N 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4590
Mailing Address - Country:US
Mailing Address - Phone:480-941-4247
Mailing Address - Fax:480-941-4010
Practice Address - Street 1:9825 N 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4590
Practice Address - Country:US
Practice Address - Phone:480-941-4247
Practice Address - Fax:480-941-4010
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist