Provider Demographics
NPI:1891406161
Name:TENDER LOVING CARE OF YAH INC
Entity type:Organization
Organization Name:TENDER LOVING CARE OF YAH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-804-0637
Mailing Address - Street 1:802 MASON ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2830
Mailing Address - Country:US
Mailing Address - Phone:270-804-0637
Mailing Address - Fax:
Practice Address - Street 1:802 MASON ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2830
Practice Address - Country:US
Practice Address - Phone:270-804-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty