Provider Demographics
NPI:1497002513
Name:CHRISTIANSEN, ASHLEY KAYE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KAYE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:KAYE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:1675 E SEMINOLE ST STE A1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2454
Practice Address - Country:US
Practice Address - Phone:417-597-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05107103TB0200X, 103TF0200X, 103TM1800X, 103TF0200X, 103TM1800X
MO2016004271103TC0700X, 103TF0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490029638Medicaid