Provider Demographics
NPI:1760164933
Name:CHANEY, ASHTON
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:CHANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 BEDFORD TILLMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:ROXIE
Mailing Address - State:MS
Mailing Address - Zip Code:39661-6129
Mailing Address - Country:US
Mailing Address - Phone:228-284-8149
Mailing Address - Fax:
Practice Address - Street 1:1789 BEDFORD TILLMAN RD NW
Practice Address - Street 2:
Practice Address - City:ROXIE
Practice Address - State:MS
Practice Address - Zip Code:39661-6129
Practice Address - Country:US
Practice Address - Phone:228-284-8149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician