=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982393781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOLF CREEK COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2023
-----------------------------------------------------
Last Update Date | 05/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14987 W HIGHWAY 80
-----------------------------------------------------
City | NANCY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42544-9020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-872-2977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14987 W HIGHWAY 80
-----------------------------------------------------
City | NANCY
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42544-9020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-872-2977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTY RAINWATER
-----------------------------------------------------
Credential | LPCC, NCC
-----------------------------------------------------
Telephone | 606-872-2977
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------