Healthcare Provider Details

I. General information

NPI: 1225334337
Provider Name (Legal Business Name): POSSIBILITY PLACE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CAMBRIDGE CT
VINE GROVE KY
40175-5100
US

IV. Provider business mailing address

56 CAMBRIDGE CT
VINE GROVE KY
40175-5100
US

V. Phone/Fax

Practice location:
  • Phone: 270-501-0858
  • Fax: 270-828-8051
Mailing address:
  • Phone: 270-501-0858
  • Fax: 270-828-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1095557
License Number StateFL

VIII. Authorized Official

Name: MICHAEL TROTTA
Title or Position: PRESIDENT
Credential:
Phone: 270-501-0858