Provider Demographics
NPI:1134882103
Name:EVERLASTING HOPE FAMILY COUNSELING
Entity type:Organization
Organization Name:EVERLASTING HOPE FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGOON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-305-1820
Mailing Address - Street 1:87 ROLLING CT
Mailing Address - Street 2:
Mailing Address - City:EKRON
Mailing Address - State:KY
Mailing Address - Zip Code:40117-8649
Mailing Address - Country:US
Mailing Address - Phone:270-305-1820
Mailing Address - Fax:
Practice Address - Street 1:668 BYPASS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1730
Practice Address - Country:US
Practice Address - Phone:270-305-1820
Practice Address - Fax:833-384-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100694080Medicaid