MEDICARE: ASHLEY KLAMFOTH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	30301	TX
2	1041C0700X	Clinical Social Worker	30301	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8L10454	OTHER	TX	MEDICARE ID

General Provider Information

NPI Number	:	1316982747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KLAMFOTH LCSW

Provider Business Mailing Address
First Line	:	105 CANYON LAKE CIR
Second Line	:
City	:	LUMBERTON
State	:	TX
Zip	:	77657-3701
Country	:	US
Telephone Number	:	409-200-2220
Fax Number	:	409-440-3344

Provider Business Practice Location Address
First Line	:	105 CANYON LAKE CIR
Second Line	:
City	:	LUMBERTON
State	:	TX
Zip	:	77657-3701
Country	:	US
Telephone Number	:	409-200-2220
Fax Number	:	409-440-3344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/14/2023

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