Healthcare Provider Details

I. General information

NPI: 1659326239
Provider Name (Legal Business Name): STEVEN D VICE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CLINIC DR
MOREHEAD KY
40351-1077
US

IV. Provider business mailing address

445 CLINIC DR
MOREHEAD KY
40351-1077
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6805
  • Fax: 606-783-6869
Mailing address:
  • Phone: 606-783-6805
  • Fax: 606-783-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number078
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0135
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: