Provider Demographics
NPI:1992212252
Name:SUBUH, ASHLEY A (LCMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:SUBUH
Suffix:
Gender:F
Credentials:LCMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14340 W 116TH ST APT 3201
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3856
Mailing Address - Country:US
Mailing Address - Phone:316-461-1249
Mailing Address - Fax:
Practice Address - Street 1:1511 WESTPORT RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-4307
Practice Address - Country:US
Practice Address - Phone:816-200-7266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2941106H00000X
KS2957106H00000X
MO2020019921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist