Provider Demographics
NPI:1821273152
Name:WHOLE LIFE BEHAVIORAL HEALTH PSC
Entity Type:Organization
Organization Name:WHOLE LIFE BEHAVIORAL HEALTH PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, NCC
Authorized Official - Phone:606-371-2130
Mailing Address - Street 1:32 LAWMAR RD
Mailing Address - Street 2:
Mailing Address - City:AUXIER
Mailing Address - State:KY
Mailing Address - Zip Code:41602-9278
Mailing Address - Country:US
Mailing Address - Phone:606-371-2130
Mailing Address - Fax:
Practice Address - Street 1:32 LAWMAR RD
Practice Address - Street 2:
Practice Address - City:AUXIER
Practice Address - State:KY
Practice Address - Zip Code:41602-9278
Practice Address - Country:US
Practice Address - Phone:606-371-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty