Provider Demographics
NPI:1750862702
Name:GREATER HOPE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GREATER HOPE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GATT
Authorized Official - Middle Name:READ
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-495-1224
Mailing Address - Street 1:2501 CROSSINGS BLVD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5479
Mailing Address - Country:US
Mailing Address - Phone:270-495-1224
Mailing Address - Fax:270-599-0023
Practice Address - Street 1:2501 CROSSINGS BLVD
Practice Address - Street 2:SUITE 137
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-495-1224
Practice Address - Fax:270-599-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY810638101Y00000X, 261Q00000X
KY164501101YA0400X
KY118186101YA0400X
KY104259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1750862702Medicaid