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General NPI Number Information
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NPI Number | 1659289197
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Entity Type | Organization
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Legal Business Name | WILLOWS WAY BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 103 S WALNUT ST
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City | PINEVILLE
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State | KY
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Zip | 40977-1619
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Country | US
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Telephone | 606-302-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 103 S WALNUT ST
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City | PINEVILLE
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State | KY
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Zip | 40977-1619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. SANDRA MIRACLE
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Credential | LPCA
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Telephone | 606-302-1834
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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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