Provider Demographics
NPI:1649477464
Name:HATFIELD, LUKE HAYDEN
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:HAYDEN
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4237
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-4237
Mailing Address - Country:US
Mailing Address - Phone:270-230-1777
Mailing Address - Fax:270-679-0838
Practice Address - Street 1:346 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1428
Practice Address - Country:US
Practice Address - Phone:270-230-1777
Practice Address - Fax:270-679-0838
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1293101YM0800X, 101YP2500X
KY0577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30600518Medicaid
KY7100296780Medicaid