Provider Demographics
NPI:1316204704
Name:STAVIG, ASHLEY MICHELE (LMHC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MICHELE
Last Name:STAVIG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 40TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3841
Mailing Address - Country:US
Mailing Address - Phone:515-360-6199
Mailing Address - Fax:
Practice Address - Street 1:1200 VALLEY WEST DR STE 302
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1904
Practice Address - Country:US
Practice Address - Phone:515-267-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12507516OtherCAQH