Provider Demographics
NPI:1700178456
Name:SOZO WELLNESS CENTER
Entity Type:Organization
Organization Name:SOZO WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-545-9478
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:BIMBLE
Mailing Address - State:KY
Mailing Address - Zip Code:40915-0423
Mailing Address - Country:US
Mailing Address - Phone:606-545-9478
Mailing Address - Fax:606-546-3903
Practice Address - Street 1:4671 SOUTH CUMBERLAND GAP PARKWAY
Practice Address - Street 2:
Practice Address - City:BIMBLE
Practice Address - State:KY
Practice Address - Zip Code:40915
Practice Address - Country:US
Practice Address - Phone:606-545-9478
Practice Address - Fax:606-546-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty