Provider Demographics
NPI:1063893493
Name:ASHLAND CENTER FOR COUPLES
Entity type:Organization
Organization Name:ASHLAND CENTER FOR COUPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LMFT
Authorized Official - Phone:541-708-1403
Mailing Address - Street 1:479 RUSSELL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-7331
Mailing Address - Country:US
Mailing Address - Phone:541-708-1403
Mailing Address - Fax:
Practice Address - Street 1:479 RUSSELL ST STE 102
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-7331
Practice Address - Country:US
Practice Address - Phone:541-708-1403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty