Healthcare Provider Details

I. General information

NPI: 1700178456
Provider Name (Legal Business Name): SOZO WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 SOUTH CUMBERLAND GAP PARKWAY
BIMBLE KY
40915
US

IV. Provider business mailing address

PO BOX 423
BIMBLE KY
40915-0423
US

V. Phone/Fax

Practice location:
  • Phone: 606-545-9478
  • Fax: 606-546-3903
Mailing address:
  • Phone: 606-545-9478
  • Fax: 606-546-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MISS HOLLY R TAYLOR
Title or Position: THERAPIST
Credential: LPCC
Phone: 606-545-9478