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General NPI Number Information
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NPI Number | 1316630643
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Entity Type | Individual
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Provider Name | PHILLIP MATTHEW STEELY
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Gender | Male
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 291 ALLISON BLVD
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City | CORBIN
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State | KY
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Zip | 40701-7964
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Country | US
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Telephone | 606-404-4649
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Fax |
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Provider Business Mailing Address
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Address Line | 127 QUICK RD
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City | NEW CARLISLE
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State | OH
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Zip | 45344-9253
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 256857
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License Number State | KY
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