MEDICARE: YELLOW WOOD COUNSELING, 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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1760954770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELLOW WOOD COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1005 E 15TH AVE STE E
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3002
Country	:	US
Telephone Number	:	270-287-3351
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 E 15TH AVE STE E
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-3002
Country	:	US
Telephone Number	:	270-287-3351
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW SKAGGS
Credential	:
Telephone Number	:	270-287-3351

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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