Provider Demographics
NPI:1003334780
Name:HUNDLEY, MARTIN BENNETT (LPCA)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:BENNETT
Last Name:HUNDLEY
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:B
Other - Last Name:HUNDLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:510 MALLARD PARK
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383
Mailing Address - Country:US
Mailing Address - Phone:859-396-9511
Mailing Address - Fax:
Practice Address - Street 1:274 SOUTHLAND DR # 204
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty