Provider Demographics
NPI:1700626090
Name:PHILLIPS, ASHLEY (MA, MT-BC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MOODY ST APT 18-10
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5332
Mailing Address - Country:US
Mailing Address - Phone:214-552-9982
Mailing Address - Fax:
Practice Address - Street 1:67 UNION ST FL 3
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:781-396-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist