Provider Demographics
NPI:1346612884
Name:THE PROVISION SCHOOL AND FAMILY COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:THE PROVISION SCHOOL AND FAMILY COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-396-0644
Mailing Address - Street 1:128 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2917
Mailing Address - Country:US
Mailing Address - Phone:859-396-0644
Mailing Address - Fax:
Practice Address - Street 1:128 DENNIS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2917
Practice Address - Country:US
Practice Address - Phone:859-396-0644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9083251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health