Healthcare Provider Details

I. General information

NPI: 1750944922
Provider Name (Legal Business Name): MARK DANIEL PLYMALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 NEWTOWN PIKE BLDG 1
LEXINGTON KY
40511-1277
US

IV. Provider business mailing address

1351 NEWTOWN PIKE BLDG 1
LEXINGTON KY
40511-1277
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-0444
  • Fax:
Mailing address:
  • Phone: 859-253-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number175012
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: