Healthcare Provider Details

I. General information

NPI: 1477458487
Provider Name (Legal Business Name): PHOENIX & OAK WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 US 60 SUITE 2
ASHLAND KY
41102-9508
US

IV. Provider business mailing address

6341 STATE HIGHWAY 2
OLIVE HILL KY
41164-8684
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-4444
  • Fax:
Mailing address:
  • Phone: 606-831-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: VANESSA MAE INGLE
Title or Position: OWNER/MANAGING MEMBER
Credential: LPCC
Phone: 606-831-4444