Provider Demographics
NPI:1124419148
Name:INTERFAITH COUNSELING CENTER
Entity Type:Organization
Organization Name:INTERFAITH COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:859-258-2060
Mailing Address - Street 1:240 RODES AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2615
Mailing Address - Country:US
Mailing Address - Phone:859-258-2060
Mailing Address - Fax:
Practice Address - Street 1:240 RODES AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2615
Practice Address - Country:US
Practice Address - Phone:859-258-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0204251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health