Provider Demographics
NPI:1801328307
Name:ASHLOCK, PATRICIA (LMSW, LCAC)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:ASHLOCK
Suffix:
Gender:F
Credentials:LMSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E HARRY ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5089
Mailing Address - Country:US
Mailing Address - Phone:316-788-1664
Mailing Address - Fax:316-788-1670
Practice Address - Street 1:9415 E HARRY ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5089
Practice Address - Country:US
Practice Address - Phone:316-788-1664
Practice Address - Fax:316-788-1670
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS259101YA0400X
KS5536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200623440AMedicaid