Provider Demographics
NPI:1508415324
Name:STAPLES, ASHLIE DESERAI
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:DESERAI
Last Name:STAPLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:DESERAI
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3595 E FOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1733
Mailing Address - Country:US
Mailing Address - Phone:270-604-9423
Mailing Address - Fax:
Practice Address - Street 1:3595 E FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1733
Practice Address - Country:US
Practice Address - Phone:270-604-9423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248641101YP2500X
COLPC.0018447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional