Basic Information
| Provider Information | |||||||||
| NPI: | 1952771933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTON | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32100 TELEGRAPH RD | ||||||||
| Address2: | SUITE NUMBER 203 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480252452 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 32100 TELEGRAPH RD | ||||||||
| Address2: | SUITE NUMBER 203 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480252452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487124266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2015 | ||||||||
| LastUpdateDate: | 10/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 00000000000 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.