Provider Demographics
NPI:1548604630
Name:MICHAELS, ASHLEY RENEE (MA, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RENEE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:RENEE
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1119 E RUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3460
Mailing Address - Country:US
Mailing Address - Phone:229-251-7930
Mailing Address - Fax:
Practice Address - Street 1:1119 E RUSHWOOD DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3460
Practice Address - Country:US
Practice Address - Phone:229-251-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-34200103K00000X
NC1-18-34200103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst