1427837376 NPI number — NURTURED BEGINNINGS LCSW THERAPY, PLLC

Table of content: KEVIN ANDREW HOUGH D.O. (NPI 1174581870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427837376 NPI number — NURTURED BEGINNINGS LCSW THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURTURED BEGINNINGS LCSW THERAPY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427837376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 W BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HORSEHEADS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14845-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-252-4519
Provider Business Mailing Address Fax Number:
607-213-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HORSEHEADS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14845-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-252-4519
Provider Business Practice Location Address Fax Number:
607-213-3154
Provider Enumeration Date:
09/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BARTLE-BUSH
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED CLINICAL SOCIAL WORKER/OWN
Authorized Official Telephone Number:
607-252-4519

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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