Provider Demographics
NPI:1629265145
Name:THIBODEAU, ASHLEY D (MHRT-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2041
Mailing Address - Country:US
Mailing Address - Phone:207-764-0759
Mailing Address - Fax:207-764-5631
Practice Address - Street 1:2 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2041
Practice Address - Country:US
Practice Address - Phone:207-764-0759
Practice Address - Fax:207-764-5631
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health