Provider Demographics
NPI:1932566544
Name:APPALACHIAN WELLNESS, L.L.C.
Entity Type:Organization
Organization Name:APPALACHIAN WELLNESS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ROSE HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPP
Authorized Official - Phone:606-668-7393
Mailing Address - Street 1:PO BOX 1136
Mailing Address - Street 2:592 KY 15 SOUTH, SUITE 5
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-1136
Mailing Address - Country:US
Mailing Address - Phone:606-668-7393
Mailing Address - Fax:866-718-4137
Practice Address - Street 1:592 KY 15 SOUTH
Practice Address - Street 2:SUITE 5
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301
Practice Address - Country:US
Practice Address - Phone:606-668-7393
Practice Address - Fax:866-718-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPSYPPR00216468103TC0700X
KY41931273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No273R00000XHospital UnitsPsychiatric UnitGroup - Multi-Specialty