Healthcare Provider Details

I. General information

NPI: 1881810471
Provider Name (Legal Business Name): WILLIAM BRENT COLWICK M.A., LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 HUNTERS TRCE
LA GRANGE KY
40031-8200
US

IV. Provider business mailing address

1908 HUNTERS TRCE
LA GRANGE KY
40031-8200
US

V. Phone/Fax

Practice location:
  • Phone: 502-314-6996
  • Fax:
Mailing address:
  • Phone: 502-314-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number103555
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: