Provider Demographics
NPI:1609214717
Name:SCROGGINS, ASHLEY MARIE (MS, CLINICAL MENTAL)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:MS, CLINICAL MENTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35090 GOSS LN
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7788
Mailing Address - Country:US
Mailing Address - Phone:918-839-4710
Mailing Address - Fax:
Practice Address - Street 1:502 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4216
Practice Address - Country:US
Practice Address - Phone:918-647-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health