NPIMap

Organization Active NPI

Ashleybrook Clinic PA

  • Mental Health Counselor
  • Winston Salem, NC
National Provider Identifier
1699828475
Registry record updated Aug 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
28930 Issued in NC
Legal business name
ASHLEYBROOK CLINIC PA
Practice address
1321 Ashleybrook Lane
Winston Salem, NC 27103-2918
Phone
(336) 659-9045
Fax
(336) 659-7866
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Thai T Phan, MD
Title
President
Phone
(336) 659-9045

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 28930 NC Primary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 28930 NC
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 28930 NC

Addresses

Primary practice location

1321 Ashleybrook Lane
Winston Salem, NC 27103-2918

Mailing address

1321 Ashleybrook Lane
Winston Salem, NC 27103-2918
Phone (336) 659-9045

Other identifiers 1

IdentifierTypeStateIssuer
0152FOtherNCBCBS

National Provider Directory

National Provider Directory

Locations

1321 Ashleybrook Ln
Winston Salem, NC 27103
Phone (336) 659-9045

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1699828475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1321 ASHLEYBROOK LANE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032918",
            "telephone_number": "336-659-9045",
            "fax_number": "336-659-7866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 ASHLEYBROOK LANE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271032918",
            "telephone_number": "336-659-9045",
            "fax_number": "336-659-7866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASHLEYBROOK CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "THAI",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-659-9045",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "28930",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "28930",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NC",
            "license": "28930",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0152F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.