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General NPI Number Information
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NPI Number | 1396238051
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Entity Type | Organization
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Legal Business Name | BOUNCING BACK COUNSELING INC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 01/21/2023
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Provider Practice Location Address
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Address Line | 375 TOWN BRANCH RD STE 2
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City | MANCHESTER
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State | KY
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Zip | 40962-1326
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Country | US
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Telephone | 606-598-0070
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Fax | 844-373-1765
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Provider Business Mailing Address
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Address Line | 514 DANVILLE AVE
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City | STANFORD
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State | KY
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Zip | 40484-1104
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Country | US
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Telephone | 606-598-0070
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Fax | 844-373-1765
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | CHERYL K. GIBSON
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Credential |
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Telephone | 606-598-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 810612
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License Number State | KY
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