MEDICARE: JUDITH HAWK

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
1	101YM0800X	Mental Health Counselor	106465	KY

General Provider Information

NPI Number	:	1811647282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH HAWK

Provider Business Mailing Address
First Line	:	1848 HAVERWOOD PARK
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40514-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 N BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40507-1270
Country	:	US
Telephone Number	:	859-266-6886
Fax Number	:	859-268-0886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/28/2022

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Directions to “ JUDITH HAWK ” Practice Location

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