NPIMap

Organization Active NPI

Mark Modlin, Inc.

  • Counselor
  • Edgewood, KY
National Provider Identifier
1881003705
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
KY-0206 Issued in KY
Legal business name
MARK MODLIN, INC.
Practice address
130 Dudley Pike
Suite 120
Edgewood, KY 41017-2396
Phone
(859) 341-7170
Fax
(859) 341-7173
NPI assigned
Aug 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Alan Modlin, M.S., N.C.C.NPI 1417375353
Title
Owner
Phone
(859) 341-7170

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X KY-0206 KY Primary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X C.0001640 OH
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X KY-0206 KY
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X C.0001640 OH
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X KY-0206 KY
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X C.0001640 OH

Addresses

Primary practice location

130 Dudley Pike
Suite 120
Edgewood, KY 41017-2396

Mailing address

130 Dudley Pike
Suite 120
Edgewood, KY 41017-2396
Phone (859) 341-7170

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1881003705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DUDLEY PIKE",
            "address_2": "SUITE 120",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410172396",
            "telephone_number": "859-341-7170",
            "fax_number": "859-341-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DUDLEY PIKE",
            "address_2": "SUITE 120",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410172396",
            "telephone_number": "859-341-7170",
            "fax_number": "859-341-7173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK MODLIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "MODLIN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "859-341-7170",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S., N.C.C."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "KY",
            "license": "KY-0206",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.0001640",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KY",
            "license": "KY-0206",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "C.0001640",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "KY-0206",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.0001640",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.