Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 270405 | KY |
N | 225C00000X | Rehabilitation Counselor |
NPI | 1336630490 |
---|---|
Provider Name | Autumn Minch |
First Address | Bowling Green, KY 42103-7956 |
Second Address | Bowling Green, KY 42103-7956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30604011 | (05) | KY |