Provider Demographics
NPI:1912291550
Name:ALLGOOD, ASHLEY BRIANA (BSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BRIANA
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BRIANA
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 E CHARLESTON BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6682
Mailing Address - Country:US
Mailing Address - Phone:702-968-5000
Mailing Address - Fax:
Practice Address - Street 1:4000 E CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6682
Practice Address - Country:US
Practice Address - Phone:702-968-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
NV6750-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner