| Dr. William H. Fuller Memorial Substance Abuse Treatment Center | |
|
1525 Cuba Rd Mayfield KY 42066-6809 | |
| (270) 247-2588 | |
| (270) 247-0142 |
| Full Name | Dr. William H. Fuller Memorial Substance Abuse Treatment Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1525 Cuba Rd, Mayfield, Kentucky |
| Authorized Official Name and Position | Terry Hudspeth (PRESIDENT/CEO) |
| Authorized Official Contact | 2704412171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. William H. Fuller Memorial Substance Abuse Treatment Center 1525 Cuba Rd Mayfield KY 42066-6809 Ph: () - | Dr. William H. Fuller Memorial Substance Abuse Treatment Center 1525 Cuba Rd Mayfield KY 42066-6809 Ph: (270) 247-2588 |
| NPI Number | 1164964201 |
|---|---|
| Provider Enumeration Date | 11/07/2016 |
| Last Update Date | 04/06/2023 |
| Certification Date | 04/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164964201 | NPI | - | NPPES |
| 27001015 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 810023 (Kentucky) | Primary |
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