Provider Demographics
NPI:1659326239
Name:VICE, STEVEN D (MA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:VICE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1077
Mailing Address - Country:US
Mailing Address - Phone:606-783-6805
Mailing Address - Fax:606-783-6869
Practice Address - Street 1:445 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1077
Practice Address - Country:US
Practice Address - Phone:606-783-6805
Practice Address - Fax:606-783-6869
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY078103T00000X
KY0135103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY89000145Medicaid
0597006Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NO.