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General NPI Number Information
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NPI Number | 1922214956
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Entity Type | Organization
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Legal Business Name | RIDGE OUTPATIENT COUNSELING, LLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 3050 RIO DOSA DR
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City | LEXINGTON
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State | KY
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Zip | 40509-1540
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Country | US
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Telephone | 859-269-2325
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Fax | 859-268-6472
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Provider Business Mailing Address
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Address Line | 3050 RIO DOSA DR
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City | LEXINGTON
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State | KY
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Zip | 40509-1540
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Country | US
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Telephone | 859-269-2325
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Fax | 859-268-6472
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. TERRI W HANCOCK
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Credential |
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Telephone | 859-268-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 100534
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License Number State | KY
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