Provider Demographics
NPI:1891381620
Name:SHADOW HORSE COUNSELING, LLC
Entity Type:Organization
Organization Name:SHADOW HORSE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-310-1844
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31823-0084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5700 SPRING ST
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:31830-2164
Practice Address - Country:US
Practice Address - Phone:229-310-1844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty