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General NPI Number Information
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NPI Number | 1649720467
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Entity Type | Organization
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Legal Business Name | STIRRUP CHANGE, LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 151 SCHOLL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-7708
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Country | US
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Telephone | 270-585-2506
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Fax |
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Provider Business Mailing Address
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Address Line | 151 SCHOLL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-7708
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Country | US
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Telephone | 270-585-2506
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CHARLENE SCOTT
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Credential | LPCC, NBCC, RPT
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Telephone | 270-585-2506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 164084
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License Number State | KY
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