Provider Demographics
NPI:1740659333
Name:DECOU, ASHLEY (MA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DECOU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-1944
Mailing Address - Country:US
Mailing Address - Phone:269-919-2005
Mailing Address - Fax:
Practice Address - Street 1:350 E MICHIGAN AVE STE 516
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3856
Practice Address - Country:US
Practice Address - Phone:269-205-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018055101Y00000X
MI6301016470103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling