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NPI Code Detail

MEDICARE: ASHLEY KETCHUM LCSW

MEDICARE: ASHLEY KETCHUM 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
11041C0700XClinical Social Worker52922TX

General Provider Information

NPI Number : 1366204414
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY KETCHUM LCSW
Provider Business Mailing Address
First Line : 905 W CANTEY ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-3205
Country : US
Telephone Number : 817-382-1876
Fax Number :
Provider Business Practice Location Address
First Line : 905 W CANTEY ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-3205
Country : US
Telephone Number : 512-694-2016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2024
Last Update Date : 01/14/2026

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Directions to “ ASHLEY KETCHUM LCSW” Practice Location

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