Healthcare Provider Details

I. General information

NPI: 1770067324
Provider Name (Legal Business Name): THE TRAUMA-INFORMED COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 MILLPOND RD. SUITE B-3
LEXINGTON KY
40514
US

IV. Provider business mailing address

713 MILLPOND RD. SUITE B-3
LEXINGTON KY
40514
US

V. Phone/Fax

Practice location:
  • Phone: 859-309-2877
  • Fax:
Mailing address:
  • Phone: 859-309-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAUREN ELIZABETH DOWNEY
Title or Position: OWNER
Credential:
Phone: 859-309-2877