Provider Demographics
NPI:1285149906
Name:ASHLOCK, KATHI IULA
Entity type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:IULA
Last Name:ASHLOCK
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 1:17079 PRIVATE ROAD 2251
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-7643
Mailing Address - Country:US
Mailing Address - Phone:325-529-3192
Mailing Address - Fax:325-529-3192
Practice Address - Street 1:17079 PRIVATE ROAD 2251
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-7643
Practice Address - Country:US
Practice Address - Phone:325-529-3192
Practice Address - Fax:325-529-3192
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities