Provider Demographics
NPI:1710304795
Name:BRICK BY BRICK MENTAL HEALTH COUNSELING AND SPIRITUAL GUIDANCE
Entity Type:Organization
Organization Name:BRICK BY BRICK MENTAL HEALTH COUNSELING AND SPIRITUAL GUIDANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HARDY GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, NCC
Authorized Official - Phone:740-577-5289
Mailing Address - Street 1:12436 STATE ROUTE 139
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9705
Mailing Address - Country:US
Mailing Address - Phone:740-577-5289
Mailing Address - Fax:606-932-2453
Practice Address - Street 1:102 BIGGS LANE
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:740-577-5289
Practice Address - Fax:606-932-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1487978557Medicaid