Provider Demographics
NPI:1922601376
Name:AMAZING LIFE-KY, LLC
Entity Type:Organization
Organization Name:AMAZING LIFE-KY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC-S
Authorized Official - Phone:989-708-0479
Mailing Address - Street 1:351 PASCOE BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6302
Mailing Address - Country:US
Mailing Address - Phone:270-904-4945
Mailing Address - Fax:270-721-0988
Practice Address - Street 1:351 PASCOE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6302
Practice Address - Country:US
Practice Address - Phone:270-904-4945
Practice Address - Fax:270-721-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health