Provider Demographics
NPI:1376877498
Name:EASTON-HOGG, EDD DOUGLAS (PSYD)
Entity Type:Individual
Prefix:
First Name:EDD
Middle Name:DOUGLAS
Last Name:EASTON-HOGG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N BROADWAY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2212
Mailing Address - Country:US
Mailing Address - Phone:859-779-0616
Mailing Address - Fax:
Practice Address - Street 1:246 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-9369
Practice Address - Country:US
Practice Address - Phone:606-464-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
KY130240103T00000X, 103TC0700X
KYKY-1778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist