Provider Demographics
NPI:1376907378
Name:SCREEN DOOR COUNSELING, LLC
Entity Type:Organization
Organization Name:SCREEN DOOR COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-307-1935
Mailing Address - Street 1:400 E MAIN AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-6900
Mailing Address - Country:US
Mailing Address - Phone:270-307-1935
Mailing Address - Fax:
Practice Address - Street 1:400 E MAIN AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6900
Practice Address - Country:US
Practice Address - Phone:270-307-1935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty