Provider Demographics
NPI:1336622513
Name:HUNDLEY, MARY F (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:HUNDLEY
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1929 OLD IRONSIDES AVE
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-4173
Mailing Address - Country:US
Mailing Address - Phone:502-624-1935
Mailing Address - Fax:
Practice Address - Street 1:1929 OLD IRONSIDES AVE
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-4173
Practice Address - Country:US
Practice Address - Phone:502-624-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3697103TC0700X
KY171260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical