Provider Demographics
NPI:1922359629
Name:REAM, ASHURINA
Entity Type:Individual
Prefix:
First Name:ASHURINA
Middle Name:
Last Name:REAM
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 1:20403 N LAKE PLEASANT RD # 117-134
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9702
Mailing Address - Country:US
Mailing Address - Phone:248-534-0232
Mailing Address - Fax:866-447-7727
Practice Address - Street 1:20403 N LAKE PLEASANT RD # 117-134
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9702
Practice Address - Country:US
Practice Address - Phone:248-534-0232
Practice Address - Fax:866-447-7727
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015147103TC0700X
AZ4590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301015147OtherLICENSE #
AZ4590OtherLICENSE #