Provider Demographics
NPI:1184066946
Name:ATWOOD, ASHLEY R (MS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BLACK SANDS WAY
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141-9827
Mailing Address - Country:US
Mailing Address - Phone:989-430-4942
Mailing Address - Fax:
Practice Address - Street 1:2308 1ST ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-2403
Practice Address - Country:US
Practice Address - Phone:989-430-4942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health