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General NPI Number Information
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NPI Number | 1376930461
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Entity Type | Organization
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Legal Business Name | VITAL LIVING COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 04/16/2015
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 1021 MAJESTIC DR STE 100
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City | LEXINGTON
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State | KY
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Zip | 40513-1884
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Country | US
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Telephone | 859-327-1117
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Fax | 859-422-5063
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Provider Business Mailing Address
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Address Line | 1021 MAJESTIC DR STE 100
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City | LEXINGTON
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State | KY
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Zip | 40513-1884
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Country | US
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Telephone | 859-327-1117
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Fax | 859-422-5063
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Authorized Official
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Title or Position | MANAGER/PSYCHOTHERAPIST
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Name | MICHAEL ROGERS
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Credential | M.A.
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Telephone | 859-327-1117
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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 | KY-1185
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License Number State | KY
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