Provider Demographics
NPI:1821674821
Name:ASH, ELIZABETH CLAIRE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:ASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4703
Mailing Address - Country:US
Mailing Address - Phone:817-583-0777
Mailing Address - Fax:
Practice Address - Street 1:2790 KELLER HICKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9610
Practice Address - Country:US
Practice Address - Phone:855-694-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-114971106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician