| NPI | 1720598592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH LAKES Owner 606-658-9775 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 0224) |
| 101YM0800X Counselor Mental Health (Licence: KY 0224) | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2020-10-26 |