Provider Demographics
NPI:1700467149
Name:ASBURRY GROUP LLC
Entity type:Organization
Organization Name:ASBURRY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASBURRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-402-1711
Mailing Address - Street 1:34406 N 27TH DR STE 140
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6079
Mailing Address - Country:US
Mailing Address - Phone:602-402-1711
Mailing Address - Fax:
Practice Address - Street 1:34406 N 27TH DR STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6079
Practice Address - Country:US
Practice Address - Phone:602-402-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-17
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1700467149OtherBCBS, CIGNA