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: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E COLLEGE AVE APT 1003
STANTON KY
40380-2381
US

IV. Provider business mailing address

124 W MAIN ST
MT STERLING KY
40353-1349
US

V. Phone/Fax

Practice location:
  • Phone: 606-481-6043
  • Fax:
Mailing address:
  • Phone: 859-498-5230
  • Fax: 859-498-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9535
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number175012
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: