Provider Demographics
NPI:1932518982
Name:DR EDD EASTON HOGG PSYD PLLC
Entity Type:Organization
Organization Name:DR EDD EASTON HOGG PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EDD
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTON-HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:859-779-0616
Mailing Address - Street 1:210 N BROADWAY ST
Mailing Address - Street 2:5
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2212
Mailing Address - Country:US
Mailing Address - Phone:859-779-0616
Mailing Address - Fax:
Practice Address - Street 1:210 N BROADWAY ST
Practice Address - Street 2:5
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2212
Practice Address - Country:US
Practice Address - Phone:859-779-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY130240OtherLICENSE