Healthcare Provider Details

I. General information

NPI: 1134861461
Provider Name (Legal Business Name): TERRY MONROE CROMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CLIFTY ST
SOMERSET KY
42503-1765
US

IV. Provider business mailing address

275 TERRY ST
MOUNT VERNON KY
40456-2127
US

V. Phone/Fax

Practice location:
  • Phone: 800-805-6989
  • Fax:
Mailing address:
  • Phone: 606-731-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number296606
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: