| Breath Of Grace Wellness | |
|
404 Public Sq Columbia KY 42728-1458 | |
| (270) 634-9346 | |
| Not Available |
| Full Name | Breath Of Grace Wellness |
|---|---|
| Speciality | Counselor |
| Location | 404 Public Sq, Columbia, Kentucky |
| Authorized Official Name and Position | Tiffany N Priddy (OWNER) |
| Authorized Official Contact | 2706349346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breath Of Grace Wellness 404 Public Sq Columbia KY 42728-1458 Ph: (270) 634-9346 | Breath Of Grace Wellness 404 Public Sq Columbia KY 42728-1458 Ph: (270) 634-9346 |
| NPI Number | 1003550575 |
|---|---|
| Provider Enumeration Date | 04/21/2022 |
| Last Update Date | 04/21/2022 |
| Certification Date | 04/21/2022 |
| Medicare PECOS PAC ID | 5799152591 |
|---|---|
| Medicare Enrollment ID | O20221108002488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003550575 | NPI | - | NPPES |
| 147992766 | Other | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Patrick Burke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356965024 PECOS PAC ID: 9335525146 Enrollment ID: I20221003000726 |
| Provider Name | Tiffany Priddy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477992766 PECOS PAC ID: 2365819885 Enrollment ID: I20240119002669 |
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