Provider Demographics
NPI:1477339315
Name:BUSTILLOS, ASHLIE RUTHANNA
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:RUTHANNA
Last Name:BUSTILLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:RUTHANNA
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LAC, CADCIII
Mailing Address - Street 1:6600 SW 105TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-8800
Mailing Address - Country:US
Mailing Address - Phone:971-245-1362
Mailing Address - Fax:
Practice Address - Street 1:6600 SW 105TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-8800
Practice Address - Country:US
Practice Address - Phone:971-245-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0018832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional