Provider Demographics
NPI:1972974186
Name:MOTHER OF GOOD COUNSEL
Entity type:Organization
Organization Name:MOTHER OF GOOD COUNSEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-666-4011
Mailing Address - Street 1:1389 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-7015
Mailing Address - Country:US
Mailing Address - Phone:606-666-4011
Mailing Address - Fax:606-666-5801
Practice Address - Street 1:1389 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-7015
Practice Address - Country:US
Practice Address - Phone:606-666-4011
Practice Address - Fax:606-666-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY800192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty