Provider Demographics
NPI:1184315400
Name:CAMPBELL, ASHLEY (BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18195 POLE GULCH RD
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-8759
Mailing Address - Country:US
Mailing Address - Phone:610-217-0574
Mailing Address - Fax:
Practice Address - Street 1:1355 GARDEN OF THE GODS RD STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3595
Practice Address - Country:US
Practice Address - Phone:719-212-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-74038103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst