Provider Demographics
NPI:1801899059
Name:ASHLEY, MICHAEL A (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SWAYZEE
Mailing Address - State:IN
Mailing Address - Zip Code:46986-9578
Mailing Address - Country:US
Mailing Address - Phone:765-661-1995
Mailing Address - Fax:888-419-8515
Practice Address - Street 1:501 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SWAYZEE
Practice Address - State:IN
Practice Address - Zip Code:46986-9578
Practice Address - Country:US
Practice Address - Phone:765-661-1995
Practice Address - Fax:888-419-8515
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090231A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33237OtherNATIONAL REGISTRY OF HEALTH SERVICE PSYCHOLOGISTS
IN200167170AMedicaid
IN11590722OtherCAQH
IN257420Medicare PIN