Healthcare Provider Details

I. General information

NPI: 1871400747
Provider Name (Legal Business Name): PRO PRACTICE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 OLD CUBA RD
EUBANK KY
42567-8793
US

IV. Provider business mailing address

216 SKYWATCH DR STE 225
DANVILLE KY
40422-2540
US

V. Phone/Fax

Practice location:
  • Phone: 502-699-4634
  • Fax: 877-313-1501
Mailing address:
  • Phone: 502-699-4634
  • Fax: 877-313-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TINTISHA CLANTON
Title or Position: OWNER
Credential:
Phone: 502-229-7820