Healthcare Provider Details

I. General information

NPI: 1841399789
Provider Name (Legal Business Name): ELIZABETHTOWN PARTNERS IN COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N MAIN ST
ELIZABETHTOWN KY
42701-1417
US

IV. Provider business mailing address

204 N MAIN ST
ELIZABETHTOWN KY
42701-1417
US

V. Phone/Fax

Practice location:
  • Phone: 270-360-1222
  • Fax: 270-360-0333
Mailing address:
  • Phone: 270-360-1222
  • Fax: 270-360-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NEWBERRY
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-360-1222