Organization
THERAPEUTIC COLLABORATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIRGINIA ELLEN PEPPERS ARNP BC (PARTNER)
(859) 572-0400
Entity
Organization
Contact information
Practice address
519 LICKING PIKE, WILDER, KY 41071
(859) 572-0400
(859) 442-3363
Mailing address
519 LICKING PIKE, WILDER, KY 41071
(859) 572-0400
(859) 442-3363
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65928897
—
KY
Enumeration date
01/24/2007
Last updated
06/17/2011
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