Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 078 | KY |
Y | 103T00000X | Psychologist | 078 | KY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 0135 | KY |
NPI | 1659326239 |
---|---|
Provider Name | Steven D Vice |
First Address | Morehead, KY 40351-1077 |
Second Address | Morehead, KY 40351-1077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 27/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89000145 | (05) | KY |