Provider Demographics
NPI:1508575333
Name:MICHOL, ASHELY (RBT)
Entity Type:Individual
Prefix:
First Name:ASHELY
Middle Name:
Last Name:MICHOL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16629 WILD HORSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1627
Mailing Address - Country:US
Mailing Address - Phone:636-777-8101
Mailing Address - Fax:636-777-8104
Practice Address - Street 1:16629 WILD HORSE CREEK RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1627
Practice Address - Country:US
Practice Address - Phone:636-777-8101
Practice Address - Fax:636-777-8104
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-19-99050106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician