Provider Demographics
NPI:1073196937
Name:EUBANK, CAYDEN LEE
Entity Type:Individual
Prefix:MISS
First Name:CAYDEN
Middle Name:LEE
Last Name:EUBANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 DECOURSEY PIKE
Mailing Address - Street 2:
Mailing Address - City:RYLAND HGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41015-9309
Mailing Address - Country:US
Mailing Address - Phone:859-816-4955
Mailing Address - Fax:
Practice Address - Street 1:1130 BOONE AIRE RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1202
Practice Address - Country:US
Practice Address - Phone:859-282-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician