Provider Demographics
NPI:1114412640
Name:MARTIN, ASHLEY (BCBA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:306
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1958
Mailing Address - Country:US
Mailing Address - Phone:615-630-0946
Mailing Address - Fax:157-309-1356
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:306
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1958
Practice Address - Country:US
Practice Address - Phone:615-630-0946
Practice Address - Fax:615-730-9135
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-18-30783103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1-18-30783OtherBCBA