Provider Demographics
NPI:1174188809
Name:HARDISON, ASHLEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:HARDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:ABIQUIU
Mailing Address - State:NM
Mailing Address - Zip Code:87510-0062
Mailing Address - Country:US
Mailing Address - Phone:505-423-5911
Mailing Address - Fax:
Practice Address - Street 1:HOUSE 9 ABIQUIU VILLAGE
Practice Address - Street 2:
Practice Address - City:ABIQUIU
Practice Address - State:NM
Practice Address - Zip Code:87510
Practice Address - Country:US
Practice Address - Phone:505-423-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician