Provider Demographics
NPI:1306672399
Name:ALLISON, ASHLEY BEASLEY (IMH)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BEASLEY
Last Name:ALLISON
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13049 BAYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6614
Mailing Address - Country:US
Mailing Address - Phone:407-567-8960
Mailing Address - Fax:
Practice Address - Street 1:600 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9578
Practice Address - Country:US
Practice Address - Phone:407-399-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health