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General NPI Number Information
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NPI Number | 1679459226
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Entity Type | Organization
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Legal Business Name | BASTET COUNSELING LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 4537 LARGO LN
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City | LEXINGTON
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State | KY
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Zip | 40515-5124
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Country | US
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Telephone | 859-327-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 4537 LARGO LN
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City | LEXINGTON
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State | KY
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Zip | 40515-5124
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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 | OWNER/THERAPIST
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Name | DAIQUIRI AMS
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Credential | LPCC
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Telephone | 859-327-0406
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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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