Basic Information
| Provider Information | |||||||||
| NPI: | 1497177398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERLASTING ARMS FAMILY COUNSELING CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7 | ||||||||
| Address2: | |||||||||
| City: | CLARKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427260007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702346139 | ||||||||
| FaxNumber: | 8558591695 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 MILLERSTOWN ST | ||||||||
| Address2: | |||||||||
| City: | CLARKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 42726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702346139 | ||||||||
| FaxNumber: | 8888591695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2014 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | RIGGS | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | OLETTA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 2702346139 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 810469 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 800193 | KY | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251B00000X | N | Agencies | Case Management | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7100299020 | 05 | KY | MEDICAID |