Mark Alan Modlin, M.S.
Counselor in Edgewood, KY. Individual provider (NPI-1).
NPI number1417375353
StatusActive
Last updated in NPPESJul 29, 2014
Details
- NPI
- 1417375353
- Entity type
- Individual (NPI-1)
- Name
- Mark Alan Modlin
- Credential
- M.S.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 28, 2014
- Last updated
- Jul 29, 2014
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101Y00000X | Counselor | KY-0206 | KY | Yes |
| 101Y00000X | Counselor | C.0001640 | OH | |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | KY-0206 | KY | |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | C.0001640 | OH | |
| 101YM0800X | Counselor, Mental Health | KY-0206 | KY | |
| 101YM0800X | Counselor, Mental Health | C.0001640 | OH | |
| 101YP2500X | Counselor, Professional | KY-0206 | KY | |
| 101YP2500X | Counselor, Professional | C.0001640 | OH |
Practice location
130 Dudley PikeSuite 120
Edgewood, KY 41017-2396
Phone 859-341-7170 · Fax 859-341-7173
Mailing address
130 Dudley PikeSuite 120
Edgewood, KY 41017-2396
Phone 859-341-7170 · Fax 859-341-7173
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