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General NPI Number Information
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NPI Number | 1699253880
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Entity Type | Organization
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Legal Business Name | BLUEGRASS WELLNESS & COUNSELING, LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 58 S MAIN ST
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City | WINCHESTER
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State | KY
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Zip | 40391-2619
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Country | US
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Telephone | 859-421-7262
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Fax | 859-878-1306
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Provider Business Mailing Address
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Address Line | 3824 MUIRFIELD PL
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City | LEXINGTON
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State | KY
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Zip | 40509-2108
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Country | US
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Telephone | 859-421-7262
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Fax | 859-878-1306
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Authorized Official
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Title or Position | OWNER
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Name | MISIT HALL
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Credential | LMFT
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Telephone | 859-421-7262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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