Healthcare Provider Details

I. General information

NPI: 1780123729
Provider Name (Legal Business Name): LIFES JOURNEY THERAPY AND COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 LICKING PIKE
WILDER KY
41071-2912
US

IV. Provider business mailing address

519 LICKING PIKE
WILDER KY
41071-2912
US

V. Phone/Fax

Practice location:
  • Phone: 859-441-2100
  • Fax: 859-441-2111
Mailing address:
  • Phone: 859-441-2100
  • Fax: 859-441-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1937
License Number StateKY

VIII. Authorized Official

Name: MRS. PAMELA M MCCARTHY
Title or Position: OWNER
Credential: LCSW
Phone: 859-441-2100