Provider Demographics
NPI:1457660920
Name:CAUDILL, ANTHONY BRENT (LPCC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BRENT
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9405
Mailing Address - Country:US
Mailing Address - Phone:606-910-4308
Mailing Address - Fax:606-439-2861
Practice Address - Street 1:466 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9405
Practice Address - Country:US
Practice Address - Phone:606-910-4308
Practice Address - Fax:606-439-2861
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional