Healthcare Provider Details

I. General information

NPI: 1962049734
Provider Name (Legal Business Name): DOWN TO EARTH PROFESSIONAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2019
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BURKESVILLE ST STE B
COLUMBIA KY
42728-1467
US

IV. Provider business mailing address

107 BURKESVILLE ST STE B
COLUMBIA KY
42728-1467
US

V. Phone/Fax

Practice location:
  • Phone: 270-380-1810
  • Fax: 270-380-1811
Mailing address:
  • Phone: 270-380-1810
  • Fax: 270-380-1811

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: ALICE ELLIS
Title or Position: OWNER/PROVIDER
Credential: LPCC
Phone: 270-380-1810