| NPI | 1558736041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH BURKE COTTLE Member 502-882-0225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY MFTMFT00223555) |
| Additional Taxonomies | 251S00000X (Licence: KY MFTMFT00223555) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2016-01-02 |