Provider Demographics
NPI:1831366327
Name:COUNSELOR'S CLINICAL COTTAGE
Entity type:Organization
Organization Name:COUNSELOR'S CLINICAL COTTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-329-0727
Mailing Address - Street 1:2740 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1929
Mailing Address - Country:US
Mailing Address - Phone:606-329-0727
Mailing Address - Fax:
Practice Address - Street 1:2740 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1929
Practice Address - Country:US
Practice Address - Phone:606-329-0727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0666101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty