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General NPI Number Information
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NPI Number | 1780109827
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH BEHAVIORAL HEALTH & COUNSELING
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 10 COURT ST
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City | MT STERLING
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State | KY
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Zip | 40353-1303
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Country | US
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Telephone | 859-520-3041
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Fax | 859-432-8935
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Provider Business Mailing Address
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Address Line | 29 N MAYSVILLE ST
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City | MT STERLING
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State | KY
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Zip | 40353-1471
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Country | US
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Telephone | 859-520-3041
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Fax | 606-329-8195
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Authorized Official
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Title or Position | CEO
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Name | CHARLOTTE ANN FARRIS
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Credential | LPCC
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Telephone | 859-520-3041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 175330
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License Number State | KY
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