Provider Demographics
NPI:1609448133
Name:MARCUM, BRITTANY
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MARCUM
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 1:2675 KY ROUTE 850
Mailing Address - Street 2:
Mailing Address - City:DAVID
Mailing Address - State:KY
Mailing Address - Zip Code:41616-8326
Mailing Address - Country:US
Mailing Address - Phone:606-483-2723
Mailing Address - Fax:
Practice Address - Street 1:6870 KY-899
Practice Address - Street 2:
Practice Address - City:PIPPA PASSES
Practice Address - State:KY
Practice Address - Zip Code:41844
Practice Address - Country:US
Practice Address - Phone:606-483-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1195718Medicaid