Basic Information
Provider Information
NPI: 1235478215
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRATT
FirstName: ASHLEY
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: CERTIFIED COUNSELOR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 231 SE BARRINGTON DR
Address2: SUITE 203
City: OAK HARBOR
State: WA
PostalCode: 982773200
CountryCode: US
TelephoneNumber: 3602400022
FaxNumber:  
Practice Location
Address1: 231 SE BARRINGTON DR
Address2: SUITE 203
City: OAK HARBOR
State: WA
PostalCode: 982773200
CountryCode: US
TelephoneNumber: 3602400022
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/11/2013
LastUpdateDate: 10/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000XCL 60205887WAY Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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