Provider Demographics
NPI:1750040606
Name:KELLUM, ASHLEY RENEE (RBT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:KELLUM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15316 HUEBNER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-0994
Mailing Address - Country:US
Mailing Address - Phone:210-797-7181
Mailing Address - Fax:
Practice Address - Street 1:15316 HUEBNER RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0994
Practice Address - Country:US
Practice Address - Phone:210-797-7181
Practice Address - Fax:210-797-7759
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician