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General NPI Number Information
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NPI Number | 1255075131
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Entity Type | Organization
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Legal Business Name | MAPLE STREET COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 308 S 12TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2342
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Country | US
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Telephone | 270-278-1658
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Fax |
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Provider Business Mailing Address
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Address Line | 308 S 12TH ST
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City | MURRAY
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State | KY
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Zip | 42071-2342
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Country | US
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Telephone | 270-278-1658
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA MARIE GABEL
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Credential | LPCC-S
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Telephone | 270-278-6168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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