Provider Demographics
NPI:1053072603
Name:BACKSCHEIDER, MOLLEY
Entity Type:Individual
Prefix:
First Name:MOLLEY
Middle Name:
Last Name:BACKSCHEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLEY
Other - Middle Name:
Other - Last Name:BACKSCHEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MHSP
Mailing Address - Street 1:2206 CUSTER LN
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41017-9244
Mailing Address - Country:US
Mailing Address - Phone:859-757-3912
Mailing Address - Fax:
Practice Address - Street 1:2206 CUSTER LN
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41017-9244
Practice Address - Country:US
Practice Address - Phone:859-757-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health