Healthcare Provider Details

I. General information

NPI: 1457660920
Provider Name (Legal Business Name): ANTHONY BRENT CAUDILL LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 VILLAGE LN
HAZARD KY
41701-9405
US

IV. Provider business mailing address

466 VILLAGE LN
HAZARD KY
41701-9405
US

V. Phone/Fax

Practice location:
  • Phone: 606-910-4308
  • Fax: 606-439-2861
Mailing address:
  • Phone: 606-910-4308
  • Fax: 606-439-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number172571
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: