=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346890134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CTG LIMITED CO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2019
-----------------------------------------------------
Last Update Date | 09/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 268 E FRIEND ST STE 101
-----------------------------------------------------
City | PRESTONSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41653-8071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-506-5055
-----------------------------------------------------
Fax | 606-506-5073
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 N ARNOLD AVE STE 504
-----------------------------------------------------
City | PRESTONSBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41653-1279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-226-1530
-----------------------------------------------------
Fax | 606-506-5073
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CYNTHIA RENEE CRASE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 606-506-5055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------