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General NPI Number Information
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NPI Number | 1376323899
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Entity Type | Organization
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Legal Business Name | ST JOHN RECOVERY & BEHAVIORAL HEALTH COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 400 E MAIN ST
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City | RICHMOND
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State | KY
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Zip | 40475-1651
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Country | US
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Telephone | 859-303-1503
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Fax |
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Provider Business Mailing Address
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Address Line | 306 ROSEDALE AVE
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City | RICHMOND
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State | KY
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Zip | 40475-1041
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Country | US
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Telephone | 859-300-1503
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PAMELA MARIE ST. JOHN
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Credential |
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Telephone | 859-319-4787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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