Provider Demographics
NPI:1265858559
Name:MUSTARD TREE COUNSELING, INC.
Entity Type:Organization
Organization Name:MUSTARD TREE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-626-0001
Mailing Address - Street 1:620 BIG HILL AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2501
Mailing Address - Country:US
Mailing Address - Phone:859-626-0001
Mailing Address - Fax:
Practice Address - Street 1:620 BIG HILL AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2501
Practice Address - Country:US
Practice Address - Phone:859-626-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1533101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty