Healthcare Provider Details

I. General information

NPI: 1073902334
Provider Name (Legal Business Name): ASSOCIATES IN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PUBLIC SQ
LEITCHFIELD KY
42754-1105
US

IV. Provider business mailing address

PO BOX 4358
LEITCHFIELD KY
42755-4358
US

V. Phone/Fax

Practice location:
  • Phone: 270-259-0004
  • Fax: 844-272-1743
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1293
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6371
License Number StateKY

VIII. Authorized Official

Name: LUKE HAYDEND HATFIELD
Title or Position: COOWNER/THERAPIST
Credential: LPCC
Phone: 270-259-0004