Provider Demographics
NPI:1508949793
Name:BOZE, ASHLEY FELTS (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FELTS
Last Name:BOZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ASHLEY
Other - Last Name:FELTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3999 FORT CAMPBELL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4929
Mailing Address - Country:US
Mailing Address - Phone:270-886-2205
Mailing Address - Fax:
Practice Address - Street 1:737B NORTH DRIVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2620
Practice Address - Country:US
Practice Address - Phone:270-890-1780
Practice Address - Fax:270-890-1789
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100296370Medicaid
KYK089770Medicare PIN