Provider Demographics
NPI:1508100447
Name:TWIN LAKES COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TWIN LAKES COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:I
Authorized Official - Credentials:MED, LPCC, NCC
Authorized Official - Phone:270-230-1777
Mailing Address - Street 1:PO BOX 4237
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-4237
Mailing Address - Country:US
Mailing Address - Phone:270-230-1777
Mailing Address - Fax:270-679-0838
Practice Address - Street 1:346 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1428
Practice Address - Country:US
Practice Address - Phone:270-230-1777
Practice Address - Fax:270-679-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100397640Medicaid