Provider Demographics
NPI:1568766699
Name:ASH, STEPHANIE J (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:ASH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 E APPLE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4481
Mailing Address - Country:US
Mailing Address - Phone:616-638-4333
Mailing Address - Fax:
Practice Address - Street 1:2735 E APPLE AVE STE E
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4481
Practice Address - Country:US
Practice Address - Phone:616-638-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011802101YP2500X
MI4101006449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist