Provider Demographics
NPI:1811468291
Name:WATERBURY, ASHLEY LYNN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:WATERBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 702
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2679
Mailing Address - Country:US
Mailing Address - Phone:615-361-4000
Mailing Address - Fax:615-815-1946
Practice Address - Street 1:100 FORBES DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-7200
Practice Address - Country:US
Practice Address - Phone:270-215-5945
Practice Address - Fax:615-815-1946
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB470615106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician