Basic Information
Provider Information
NPI: 1003003518
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HELTON
FirstName: THANH
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: M.ED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 568
Address2:  
City: CORBIN
State: KY
PostalCode: 407020568
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1203 AMERICAN GREETING CARD RD
Address2:  
City: CORBIN
State: KY
PostalCode: 407014811
CountryCode: US
TelephoneNumber: 6065287010
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/28/2007
LastUpdateDate: 09/28/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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