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General NPI Number Information
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NPI Number | 1629123443
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC COLLABORATIVE
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 519 LICKING PIKE
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City | WILDER
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State | KY
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Zip | 41071
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Country | US
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Telephone | 859-572-0400
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Fax | 859-442-3363
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Provider Business Mailing Address
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Address Line | 519 LICKING PIKE
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City | WILDER
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State | KY
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Zip | 41071
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Country | US
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Telephone | 859-572-0400
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Fax | 859-442-3363
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Authorized Official
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Title or Position | PARTNER
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Name | MS. VIRGINIA ELLEN PEPPERS
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Credential | ARNP BC
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Telephone | 859-572-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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