Provider Demographics
NPI:1699253880
Name:BLUEGRASS WELLNESS & COUNSELING, LLC
Entity type:Organization
Organization Name:BLUEGRASS WELLNESS & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISIT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:859-421-7262
Mailing Address - Street 1:3824 MUIRFIELD PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2108
Mailing Address - Country:US
Mailing Address - Phone:859-421-7262
Mailing Address - Fax:859-878-1306
Practice Address - Street 1:58 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2619
Practice Address - Country:US
Practice Address - Phone:859-421-7262
Practice Address - Fax:859-878-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty