Healthcare Provider Details

I. General information

NPI: 1730698770
Provider Name (Legal Business Name): TERRY HURST T-CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E MAIN ST
MOREHEAD KY
40351-1671
US

IV. Provider business mailing address

PO BOX 790
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-4161
  • Fax:
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number174199
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: