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General NPI Number Information
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NPI Number | 1821273152
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE BEHAVIORAL HEALTH PSC
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Dates
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Enumeration Date | 01/06/2008
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 32 LAWMAR RD
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City | AUXIER
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State | KY
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Zip | 41602-9278
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Country | US
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Telephone | 606-371-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 32 LAWMAR RD
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City | AUXIER
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State | KY
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Zip | 41602-9278
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Country | US
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Telephone | 606-371-2130
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MS. MATTIE SUBLETT
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Credential | LPCC, NCC
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Telephone | 606-371-2130
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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 | KY-0899
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License Number State | KY
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