Healthcare Provider Details

I. General information

NPI: 1851669972
Provider Name (Legal Business Name): PUCKETT COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2011
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N RACE ST
GLASGOW KY
42141-2816
US

IV. Provider business mailing address

2130 WILLIE GROCE RD
GLASGOW KY
42141-7831
US

V. Phone/Fax

Practice location:
  • Phone: 270-629-6373
  • Fax: 270-479-1302
Mailing address:
  • Phone: 270-629-6373
  • Fax: 270-479-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0615
License Number StateKY

VIII. Authorized Official

Name: MS. PEGGY SMITH-PUCKETT
Title or Position: PRESIDENT
Credential: LMFT
Phone: 270-629-6373