MEDICARE: CENTER FOR COUNSELING, HEALTH, AND WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1689041576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR COUNSELING, HEALTH, AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 24611
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40524-4611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HARRODSBURG RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3706
Country	:	US
Telephone Number	:	859-229-8222
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DAVID C. MAYNARD
Credential	:
Telephone Number	:	859-229-8222

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	08/26/2015

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