=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780526384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FLOYD HARDIN MOUNCE CPSS, CSA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2026
-----------------------------------------------------
Last Update Date | 04/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 565 HIGHWAY 192 W
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-770-5008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 565 HIGHWAY 192 W
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-770-5008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | 1221778
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------