Provider Demographics
NPI:1720516495
Name:SUNRISE PROFESSIONAL COUNSELING SERVICES
Entity Type:Organization
Organization Name:SUNRISE PROFESSIONAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-209-0036
Mailing Address - Street 1:89 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-8069
Mailing Address - Country:US
Mailing Address - Phone:606-748-2648
Mailing Address - Fax:
Practice Address - Street 1:130 CLARK ST
Practice Address - Street 2:
Practice Address - City:FLEMINGSBURG
Practice Address - State:KY
Practice Address - Zip Code:41041-1207
Practice Address - Country:US
Practice Address - Phone:606-209-0036
Practice Address - Fax:859-340-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty