Healthcare Provider Details

I. General information

NPI: 1659593176
Provider Name (Legal Business Name): DWIGHT M. TRABUE LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 ALVATON RD
ALVATON KY
42122-9657
US

IV. Provider business mailing address

9940 ALVATON RD
ALVATON KY
42122-9657
US

V. Phone/Fax

Practice location:
  • Phone: 270-746-6600
  • Fax: 270-842-9008
Mailing address:
  • Phone: 270-746-6600
  • Fax: 270-842-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0186
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: