Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003173402 |
---|---|
Provider Name | Phillip Caudill |
First Address | Prestonsburg, KY 41653-1614 |
Second Address | Prestonsburg, KY 41653-1614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 23/04/2012 |