Provider Demographics
NPI:1497591945
Name:POWELL, ASHLEY R (PSYD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:R
Other - Last Name:BAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 WISHARD BLVD STE 4110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4164
Practice Address - Country:US
Practice Address - Phone:317-944-8162
Practice Address - Fax:317-948-0609
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043802A103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264430J83OtherMEDICARE PTAN
IN300095418Medicaid