Healthcare Provider Details

I. General information

NPI: 1063615250
Provider Name (Legal Business Name): MARK A HUNT LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N. BAILEY
NORTH PLATTE NE
69103
US

IV. Provider business mailing address

PO BOX 1209 110 N. BAILEY
NORTH PLATTE NE
69103
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-6029
  • Fax: 308-534-6961
Mailing address:
  • Phone: 308-534-6029
  • Fax: 308-534-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP-521
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: