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General NPI Number Information
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NPI Number | 1124419148
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Entity Type | Organization
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Legal Business Name | INTERFAITH COUNSELING CENTER
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 240 RODES AVE
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City | LEXINGTON
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State | KY
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Zip | 40508-2615
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Country | US
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Telephone | 859-258-2060
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Fax |
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Provider Business Mailing Address
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Address Line | 240 RODES AVE
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City | LEXINGTON
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State | KY
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Zip | 40508-2615
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Country | US
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Telephone | 859-258-2060
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD LANDON
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Credential | LMFT
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Telephone | 859-258-2060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0204
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License Number State | KY
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