Provider Demographics
NPI:1184266330
Name:TUFT, ASHLEY NADENE (AM&FT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NADENE
Last Name:TUFT
Suffix:
Gender:F
Credentials:AM&FT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N VERNAL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2100
Mailing Address - Country:US
Mailing Address - Phone:435-789-1305
Mailing Address - Fax:
Practice Address - Street 1:185 N VERNAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2100
Practice Address - Country:US
Practice Address - Phone:435-789-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11285786-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11285786-3904OtherDOPL