Provider Demographics
NPI:1679001051
Name:MORROW CLINICAL MENTAL HEALTH COUNSELING
Entity Type:Organization
Organization Name:MORROW CLINICAL MENTAL HEALTH COUNSELING
Other - Org Name:MORROW CLINICAL MENTAL HEALTH COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-533-9134
Mailing Address - Street 1:1319 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1117
Mailing Address - Country:US
Mailing Address - Phone:502-636-1234
Mailing Address - Fax:
Practice Address - Street 1:1319 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1117
Practice Address - Country:US
Practice Address - Phone:502-636-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty