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General NPI Number Information
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NPI Number | 1700480308
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Entity Type | Organization
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Legal Business Name | AMAZING LIFE, LLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 351 PASCOE BLVD STE 102
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City | BOWLING GREEN
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State | KY
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Zip | 42104-6302
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Country | US
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Telephone | 270-904-4945
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Fax | 270-499-7510
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Provider Business Mailing Address
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Address Line | 384 RED BIRD TRL
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City | BOWLING GREEN
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State | KY
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Zip | 42101-0727
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Country | US
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Telephone | 270-791-5933
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Fax | 270-499-7510
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Authorized Official
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Title or Position | THERAPIST / OWNER
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Name | MR. JONATHAN DACID LEE
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Credential | LMFT
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Telephone | 270-904-4945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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