=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750863460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YELLOW BRICK ROAD COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2018
-----------------------------------------------------
Last Update Date | 07/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 198 US HIGHWAY 278 E
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35055-0690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-355-7080
-----------------------------------------------------
Fax | 256-615-8632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1324
-----------------------------------------------------
City | CULLMAN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35056-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-355-7080
-----------------------------------------------------
Fax | 256-615-8632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/COUNSELOR
-----------------------------------------------------
Name | SARAH BRICKELL
-----------------------------------------------------
Credential | EDS,NCC,RPTS,LPCS
-----------------------------------------------------
Telephone | 888-355-7080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | C2505A
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
=====================================================
Legacy Identifiers
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 14268521
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State |
-----------------------------------------------------
Identifier Issuer | CAQH
-----------------------------------------------------
=====================================================
Proprietary Identifiers Ever Reported
=====================================================
Identifier #1
-----------------------------------------------------
Identifier Code | 14268521
-----------------------------------------------------
Identifier Type | OTHER
-----------------------------------------------------
Identifier State |
-----------------------------------------------------
Identifier Issuer | CAQH
-----------------------------------------------------