Healthcare Provider Details

I. General information

NPI: 1043780729
Provider Name (Legal Business Name): WELLNESS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S MORGAN ST
MORGANFIELD KY
42437-1552
US

IV. Provider business mailing address

111 S MORGAN ST
MORGANFIELD KY
42437-1552
US

V. Phone/Fax

Practice location:
  • Phone: 270-285-9023
  • Fax: 270-285-9037
Mailing address:
  • Phone: 270-285-9023
  • Fax: 270-285-9037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: FARRAH BURGESS
Title or Position: OWNER/THERAPIST
Credential:
Phone: 270-285-9023