Provider Demographics
NPI:1144601238
Name:ABOUNDING LIFE COUNSELING AND SUPPORT, LLC
Entity Type:Organization
Organization Name:ABOUNDING LIFE COUNSELING AND SUPPORT, LLC
Other - Org Name:ABUNDANT LIVING COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH NURSE PRACTIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PMH-APRN-BC
Authorized Official - Phone:859-391-6046
Mailing Address - Street 1:265 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-4203
Mailing Address - Country:US
Mailing Address - Phone:859-391-6046
Mailing Address - Fax:
Practice Address - Street 1:265 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-4203
Practice Address - Country:US
Practice Address - Phone:859-391-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11663359OtherCAQH
KY78018033Medicaid