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General NPI Number Information
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NPI Number | 1659269504
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Entity Type | Organization
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Legal Business Name | DIVINE SOUL THERAPY LLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1099 INDIAN MOUND DR STE A
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City | MOUNT STERLING
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State | KY
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Zip | 40353-1652
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Country | US
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Telephone | 859-517-4633
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Fax | 859-203-0843
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Provider Business Mailing Address
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Address Line | 1037 HINKSTON PIKE
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9301
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Country | US
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Telephone | 859-517-4633
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Fax | 859-203-0843
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Authorized Official
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Title or Position | OWNER / CLINICAL COUNSELOR
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Name | CASEY SUE LOGAN
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Credential | M.ED., LPCC
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Telephone | 859-517-4633
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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 |
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License Number State |
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