=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649192352
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KALEIGH ASHTON MANN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2026
-----------------------------------------------------
Last Update Date | 07/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 311 N BALLARD AVE STE 201
-----------------------------------------------------
City | WYLIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75098-4638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-905-1642
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1612 TYLER DR
-----------------------------------------------------
City | ANNA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75409-1595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-584-9058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 102827
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------