Provider Demographics
NPI:1710411251
Name:HARPER, CALEB MICHAEL (MAE,NCC, LPCA)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:MICHAEL
Last Name:HARPER
Suffix:
Gender:M
Credentials:MAE,NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PHILLIP STONE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1929
Mailing Address - Country:US
Mailing Address - Phone:270-754-3494
Mailing Address - Fax:270-754-3499
Practice Address - Street 1:640 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:859-209-2335
Practice Address - Fax:859-904-4851
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY128572101YA0400X
KY171999101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)