Provider Demographics
NPI:1518629849
Name:ASHFORD, MINDY JO (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:JO
Last Name:ASHFORD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 OLD BROOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:KY
Mailing Address - Zip Code:40109-5135
Mailing Address - Country:US
Mailing Address - Phone:502-468-2112
Mailing Address - Fax:
Practice Address - Street 1:405 OLD BROOKS HILL RD
Practice Address - Street 2:
Practice Address - City:BROOKS
Practice Address - State:KY
Practice Address - Zip Code:40109-5135
Practice Address - Country:US
Practice Address - Phone:502-908-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265684103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst