# CREATE YOUR OWN PATH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427769058
- **Authorized official:** MR. TREVOR B MEAD LCSW (CEO)
- **Authorized official phone:** (270) 779-5881

## Contact information

- **Practice address:** 609 OLD HIGHWAY 60, HARDINSBURG, KY 40143-2511
- **Practice address phone:** (270) 779-5881
- **Mailing address:** PO BOX 360, HARDINSBURG, KY 40143-0360
- **Mailing address phone:** (270) 779-5881

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 12/05/2022
- **Last updated:** 12/05/2022