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General NPI Number Information
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NPI Number | 1225381601
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Entity Type | Organization
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Legal Business Name | PURCHASE AREA SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 5824 OAK LEVEL RD
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City | BENTON
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State | KY
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Zip | 42025-5269
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Country | US
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Telephone | 270-205-0141
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Fax |
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Provider Business Mailing Address
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Address Line | 5824 OAK LEVEL RD
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City | BENTON
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State | KY
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Zip | 42025-5269
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Country | US
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Telephone | 270-205-0141
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Fax | 270-527-1671
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Authorized Official
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Title or Position | OWNER
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Name | KAREN DIANE REED
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Credential | LPCC
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Telephone | 270-205-0141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0522
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License Number State | KY
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