Healthcare Provider Details

I. General information

NPI: 1750863460
Provider Name (Legal Business Name): YELLOW BRICK ROAD COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 US HIGHWAY 278 E
CULLMAN AL
35055-0690
US

IV. Provider business mailing address

PO BOX 1324
CULLMAN AL
35056-1324
US

V. Phone/Fax

Practice location:
  • Phone: 888-355-7080
  • Fax: 256-615-8632
Mailing address:
  • Phone: 800-355-7080
  • Fax: 256-615-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC2505A
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier14268521
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name: SARAH BRICKELL
Title or Position: OWNER/COUNSELOR
Credential: EDS,NCC,RPTS,LPCS
Phone: 888-355-7080