Basic Information
Provider Information | |||||||||
NPI: | 1619411840 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THERING | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | N | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMSW, QMHP, CMHP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4117 ELIZABETH ST | ||||||||
Address2: |   | ||||||||
City: | ROSEBUSH | ||||||||
State: | MI | ||||||||
PostalCode: | 488785001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9895068001 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 301 S CRAPO ST | ||||||||
Address2: | STE. 100 | ||||||||
City: | MT PLEASANT | ||||||||
State: | MI | ||||||||
PostalCode: | 488582941 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9897725938 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/07/2016 | ||||||||
LastUpdateDate: | 12/02/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/02/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6802088121 | MI | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | 6801113766 | MI | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.