Healthcare Provider Details

I. General information

NPI: 1437449451
Provider Name (Legal Business Name): ACCESS WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 REGENCY RD SUITE 101
LEXINGTON KY
40503-2914
US

IV. Provider business mailing address

2401 REGENCY RD SUITE 101
LEXINGTON KY
40503-2914
US

V. Phone/Fax

Practice location:
  • Phone: 859-309-0309
  • Fax: 859-309-0914
Mailing address:
  • Phone: 859-309-0309
  • Fax: 859-309-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY

VIII. Authorized Official

Name: WILLIAM NOLAN
Title or Position: PRESIDENT
Credential: LMFT
Phone: 859-309-0309