Individual
KEVIN J PANGBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCADC
Contact information
Practice address
4200 BUCK CREEK RD, FLOYDS KNOBS, IN 47119-9216
(502) 861-6661
Mailing address
4200 BUCK CREEK RD, FLOYDS KNOBS, IN 47119-9216
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100730680
—
KY
Enumeration date
04/06/2021
Last updated
04/07/2021
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