Provider Demographics
NPI:1710760731
Name:HISLE, ASHLIE CAMILLE
Entity Type:Individual
Prefix:
First Name:ASHLIE
Middle Name:CAMILLE
Last Name:HISLE
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 1:102 DAVENTRY LN STE 7
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2869
Mailing Address - Country:US
Mailing Address - Phone:502-917-9604
Mailing Address - Fax:
Practice Address - Street 1:102 DAVENTRY LN STE 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2869
Practice Address - Country:US
Practice Address - Phone:502-712-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty