Individual
LAURA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Mailing address
380 SUWANNEE TRAIL ST., BOWLING GREEN, KY 42101
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
171471
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100439620
—
KY
Enumeration date
07/21/2015
Last updated
11/14/2023
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