Healthcare Provider Details

I. General information

NPI: 1629694138
Provider Name (Legal Business Name): ISAIAH 43 CHRISTIAN COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2020
Last Update Date: 12/28/2021
Certification Date: 12/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W WASHINGTON ST
GLASGOW KY
42141
US

IV. Provider business mailing address

PO BOX 625
GLASGOW KY
42142-0625
US

V. Phone/Fax

Practice location:
  • Phone: 502-230-9309
  • Fax:
Mailing address:
  • Phone: 502-230-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: AMANDA K BURD
Title or Position: OWNER/THERAPIST
Credential: LPCC
Phone: 270-261-2383