Healthcare Provider Details

I. General information

NPI: 1811807449
Provider Name (Legal Business Name): PREMIER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

661 BOSTON PARK DR
BOWLING GREEN KY
42103-6902
US

IV. Provider business mailing address

661 BOSTON PARK DR
BOWLING GREEN KY
42103-6902
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

VIII. Authorized Official

Name: LACIE W MARTINEZ
Title or Position: CEO
Credential: OWNER
Phone: 270-799-1415