Provider Demographics
NPI:1376325845
Name:FERRIS, ASILEE
Entity Type:Individual
Prefix:
First Name:ASILEE
Middle Name:
Last Name:FERRIS
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 1:177 DE RODRIGUEZ LN
Mailing Address - Street 2:
Mailing Address - City:SAN MIGUEL
Mailing Address - State:NM
Mailing Address - Zip Code:88058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:177 DE RODRIGUEZ LN
Practice Address - Street 2:
Practice Address - City:SAN MIGUEL
Practice Address - State:NM
Practice Address - Zip Code:88058
Practice Address - Country:US
Practice Address - Phone:575-323-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical