Provider Demographics
NPI:1073260972
Name:FLAKE, ASHLEY D (BA, QMHP-C,A)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:D
Last Name:FLAKE
Suffix:
Gender:F
Credentials:BA, QMHP-C,A
Other - Prefix:MRS
Other - First Name:ASHLEY
Other - Middle Name:D
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, QMHP-C,A
Mailing Address - Street 1:4288 CARTEGENA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6504
Mailing Address - Country:US
Mailing Address - Phone:615-347-3115
Mailing Address - Fax:
Practice Address - Street 1:821 N 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-1505
Practice Address - Country:US
Practice Address - Phone:615-347-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733002710101YM0800X
VA0732003115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health