Healthcare Provider Details

I. General information

NPI: 1568274835
Provider Name (Legal Business Name): NURTURE AND LIGHT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 BUCKEYE CT
BOWLING GREEN KY
42104-5564
US

IV. Provider business mailing address

758 BUCKEYE CT
BOWLING GREEN KY
42104-5564
US

V. Phone/Fax

Practice location:
  • Phone: 270-799-1415
  • Fax:
Mailing address:
  • Phone: 270-799-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LACIE MARTINEZ
Title or Position: OWNER/ CEO
Credential: LPCC-S
Phone: 270-799-1415