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General NPI Number Information
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NPI Number | 1174336820
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Entity Type | Individual
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Provider Name | KENNETH EARL DANIELS
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 565 HIGHWAY 192 W
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City | LONDON
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State | KY
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Zip | 40741-2637
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Country | US
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Telephone | 606-485-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 135 WESLEY WEST RD
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City | SCIENCE HILL
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State | KY
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Zip | 42553-9069
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Country | US
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Telephone | 606-485-5188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 282007
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSA
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License Number State | KY
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