Provider Demographics
NPI:1871478107
Name:ASHLOCK, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ASHLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:WANN
Mailing Address - State:OK
Mailing Address - Zip Code:74083-0133
Mailing Address - Country:US
Mailing Address - Phone:620-330-7639
Mailing Address - Fax:
Practice Address - Street 1:213 FIRST STREET
Practice Address - Street 2:
Practice Address - City:WANN
Practice Address - State:OK
Practice Address - Zip Code:74083
Practice Address - Country:US
Practice Address - Phone:620-330-7639
Practice Address - Fax:620-330-7639
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health