MEDICARE: SEEDS OF CHANGE COUNSELING CENTER, PLLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891353504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEDS OF CHANGE COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	897 MOUNT RUSHMORE DR
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-8760
Country	:	US
Telephone Number	:	606-776-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 E MAIN ST
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-1647
Country	:	US
Telephone Number	:	859-951-4440
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MRS. STACY LYNN HARRIS
Credential	:	LCSW
Telephone Number	:	606-776-4741

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	02/15/2022

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