Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 19441 | FL |
NPI | 1295224582 |
---|---|
Provider Name | Dr. Gerald Blake Ashlock |
First Address | Dallas, TX 75254-8460 |
Second Address | Dallas, TX 75254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2018 |
Last Update Date | 02/05/2018 |