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NPI Code Detail

MEDICARE: MICHAEL CANTRELL

MEDICARE: MICHAEL CANTRELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1033630900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL CANTRELL
Provider Business Mailing Address
First Line : PO BOX 790
Second Line :
City : ASHLAND
State : KY
Zip : 41105-0790
Country : US
Telephone Number : 606-329-8588
Fax Number : 606-329-8195
Provider Business Practice Location Address
First Line : 2165 WINCHESTER AVE
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7745
Country : US
Telephone Number : 606-324-1141
Fax Number : 606-498-7325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2017
Last Update Date : 11/01/2019

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