=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477458487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX & OAK WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2026
-----------------------------------------------------
Last Update Date | 10/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 US 60 SUITE 2
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41102-9508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-831-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6341 STATE HIGHWAY 2
-----------------------------------------------------
City | OLIVE HILL
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41164-8684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-831-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING MEMBER
-----------------------------------------------------
Name | VANESSA MAE INGLE
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 606-831-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------