Provider Demographics
NPI:1801986153
Name:ASHBROOK, PATRICIA WRIGHT (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:WRIGHT
Last Name:ASHBROOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3012
Mailing Address - Country:US
Mailing Address - Phone:928-637-6425
Mailing Address - Fax:928-637-6426
Practice Address - Street 1:616 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3012
Practice Address - Country:US
Practice Address - Phone:928-637-6425
Practice Address - Fax:928-637-6426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ92443OtherMEDICARE OPT-OUT NUMBER