Provider Demographics
NPI:1225850597
Name:DIAL, ASHTYN NICOLE
Entity type:Individual
Prefix:
First Name:ASHTYN
Middle Name:NICOLE
Last Name:DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32311 N 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8080
Mailing Address - Country:US
Mailing Address - Phone:602-525-4624
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE B301
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4618
Practice Address - Country:US
Practice Address - Phone:602-525-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician