Healthcare Provider Details

I. General information

NPI: 1073100285
Provider Name (Legal Business Name): DANE JUSTIN TOSH LPCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 RUSSELLVILLE RD APT 3-312
BOWLING GREEN KY
42101-3555
US

IV. Provider business mailing address

1799 RUSSELLVILLE RD APT 3-312
BOWLING GREEN KY
42101-3555
US

V. Phone/Fax

Practice location:
  • Phone: 270-584-3477
  • Fax:
Mailing address:
  • Phone: 270-584-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number294750
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number294750
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: