Provider Demographics
NPI:1982370235
Name:CAIN, ASHLEY BURKETT
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BURKETT
Last Name:CAIN
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 1:1405 PUEBLO CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-4366
Mailing Address - Country:US
Mailing Address - Phone:903-461-1547
Mailing Address - Fax:
Practice Address - Street 1:1101 RIDGE RD STE 211
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4250
Practice Address - Country:US
Practice Address - Phone:903-461-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86397101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional