Provider Demographics
NPI:1659526994
Name:CUNNINGHAM, ASHLEY FAY (BA, CM, CADC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FAY
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:BA, CM, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2623
Mailing Address - Country:US
Mailing Address - Phone:918-812-8289
Mailing Address - Fax:
Practice Address - Street 1:111 W 5TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-4226
Practice Address - Country:US
Practice Address - Phone:918-588-8416
Practice Address - Fax:918-588-8430
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X
OK10130171M00000X
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health