Provider Demographics
NPI:1134513252
Name:MILES OF HOPE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:MILES OF HOPE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELESS-TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, ACSW
Authorized Official - Phone:606-303-3560
Mailing Address - Street 1:107 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1321
Mailing Address - Country:US
Mailing Address - Phone:606-303-3560
Mailing Address - Fax:606-365-2263
Practice Address - Street 1:107 N 2ND ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1321
Practice Address - Country:US
Practice Address - Phone:606-303-3560
Practice Address - Fax:606-365-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4004251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health