Provider Demographics
NPI:1790260867
Name:MEHUS, ASHLEY RAE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAE
Last Name:MEHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAE
Other - Last Name:HILTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1929 N WASHINGTON ST STE X
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1616
Mailing Address - Country:US
Mailing Address - Phone:701-751-2315
Mailing Address - Fax:
Practice Address - Street 1:1929 N WASHINGTON ST STE X
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1616
Practice Address - Country:US
Practice Address - Phone:701-751-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND00000106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician