Healthcare Provider Details

I. General information

NPI: 1770257677
Provider Name (Legal Business Name): PUZZLE PEACE CREATIVE COUNSELING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E MAIN ST STE 5
WILMORE KY
40390-1375
US

IV. Provider business mailing address

304 E MAIN ST STE 5
WILMORE KY
40390-1375
US

V. Phone/Fax

Practice location:
  • Phone: 888-816-1469
  • Fax: 859-788-2014
Mailing address:
  • Phone: 888-816-1469
  • Fax: 859-788-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN ROE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 617-674-3499