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NPI Code Detail

MEDICARE: WARRIOR GODDESS TRIBE, LLC

MEDICARE: WARRIOR GODDESS TRIBE, LLC
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1700631199
Entity Type Code : Organization
Provider Name (Legal Business Name) : WARRIOR GODDESS TRIBE, LLC
Provider Business Mailing Address
First Line : 801 HIGHLAND AVE
Second Line :
City : FLATWOODS
State : KY
Zip : 41139-1125
Country : US
Telephone Number : 606-744-4018
Fax Number :
Provider Business Practice Location Address
First Line : 600 SAINT CHRISTOPHER DR
Second Line :
City : ASHLAND
State : KY
Zip : 41101-7026
Country : US
Telephone Number : 606-744-4018
Fax Number :
Authorized Official
Title or Position : FOUNDER
Name : EMILY AUST
Credential : LPCA
Telephone Number : 606-744-4018
Provider Enumeration Date : 04/19/2024
Last Update Date : 04/19/2024

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Directions to “WARRIOR GODDESS TRIBE, LLC ” Practice Location

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