Provider Demographics
NPI:1700619202
Name:RAGHAV, ASHLEY LAUREN (EDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAUREN
Last Name:RAGHAV
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS
Mailing Address - Street 1:1357 BLACKTHORNE TRL N
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5604
Mailing Address - Country:US
Mailing Address - Phone:513-262-8458
Mailing Address - Fax:
Practice Address - Street 1:7203 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7967
Practice Address - Country:US
Practice Address - Phone:317-544-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10102178103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool