Healthcare Provider Details

I. General information

NPI: 1659289197
Provider Name (Legal Business Name): WILLOWS WAY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S WALNUT ST
PINEVILLE KY
40977-1619
US

IV. Provider business mailing address

103 S WALNUT ST
PINEVILLE KY
40977-1619
US

V. Phone/Fax

Practice location:
  • Phone: 606-302-1834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA MIRACLE
Title or Position: MANAGING MEMBER
Credential: LPCA
Phone: 606-302-1834