Organization
GREEN MEADOWS WELLNESS CENTER ONE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILLY FITCH (BUSINESS MANAGER)
(606) 309-1291
Entity
Organization
Contact information
Practice address
8554 KY 1232, CORBIN, KY 40701-6417
(606) 261-7622
(606) 261-7312
Mailing address
8554 KY 1232, CORBIN, KY 40701-6417
(606) 261-7622
(606) 261-7312
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TH0004X
Health Psychologist
—
—
103TH0100X
Health Service Psychologist
—
—
103TP0814X
Psychoanalysis Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
103TS0200X
School Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720730021
—
KY
05
—
7100360730
—
KY
05
—
7100406190
—
KY
05
—
7100606760
—
KY
Enumeration date
12/17/2018
Last updated
09/08/2022
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