MEDICARE: MOLLEY BACKSCHEIDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		TN

General Provider Information

NPI Number	:	1053072603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLEY BACKSCHEIDER

Provider Business Mailing Address
First Line	:	2206 CUSTER LN
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-9244
Country	:	US
Telephone Number	:	859-757-3912
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 CUSTER LN
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41017-9244
Country	:	US
Telephone Number	:	859-757-3912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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Directions to “ MOLLEY BACKSCHEIDER ” Practice Location

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