Provider Demographics
NPI:1336636877
Name:COSTA, ASHLEY LYNN (BCABA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:COSTA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34333 COASTAL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5569
Mailing Address - Country:US
Mailing Address - Phone:864-208-7380
Mailing Address - Fax:
Practice Address - Street 1:34333 COASTAL DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5569
Practice Address - Country:US
Practice Address - Phone:864-208-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRBT-16-23902106S00000X
MI0-20-11371103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician