Provider Demographics
NPI:1376930461
Name:VITAL LIVING COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:VITAL LIVING COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:859-327-1117
Mailing Address - Street 1:1021 MAJESTIC DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1884
Mailing Address - Country:US
Mailing Address - Phone:859-327-1117
Mailing Address - Fax:859-422-5063
Practice Address - Street 1:1021 MAJESTIC DR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1884
Practice Address - Country:US
Practice Address - Phone:859-327-1117
Practice Address - Fax:859-422-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty