Healthcare Provider Details

I. General information

NPI: 1205291002
Provider Name (Legal Business Name): CRITTENDEN COUNTY TOMORROW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W BELLVILLE ST
MARION KY
42064-1301
US

IV. Provider business mailing address

PO BOX 757
ELIZABETHTOWN KY
42702-0757
US

V. Phone/Fax

Practice location:
  • Phone: 270-704-3599
  • Fax:
Mailing address:
  • Phone: 270-704-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HAZEL JOSEPH
Title or Position: EMPLOYEE
Credential:
Phone: 270-704-3599