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General NPI Number Information
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NPI Number | 1457247827
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Entity Type | Organization
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Legal Business Name | BLUEGRASS COUNSELING AND PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 322 W WATER ST STE B
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City | RICHMOND
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State | KY
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Zip | 40475-3503
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Country | US
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Telephone | 859-302-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WINDWARD WAY
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City | RICHMOND
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State | KY
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Zip | 40475-7707
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Country | US
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Telephone | 859-302-0923
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Fax |
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Authorized Official
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Title or Position | OWNER, AO
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Name | MR. TRAVIS FAULKNER
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Credential | LPCC
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Telephone | 859-302-0923
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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 |
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License Number State |
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