Provider Demographics
NPI:1376778522
Name:INTERHOPE CHRISTIAN COUNSELING PLLC
Entity Type:Organization
Organization Name:INTERHOPE CHRISTIAN COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-547-4536
Mailing Address - Street 1:1454 DIEDERICH BLVD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1719
Mailing Address - Country:US
Mailing Address - Phone:606-547-4536
Mailing Address - Fax:866-511-5587
Practice Address - Street 1:1454 DIEDERICH BLVD
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1719
Practice Address - Country:US
Practice Address - Phone:606-547-4536
Practice Address - Fax:866-511-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01149Medicare PIN