Provider Demographics
NPI:1679127781
Name:KW CONSULTING, LLC
Entity type:Organization
Organization Name:KW CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:WATT
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:270-791-8189
Mailing Address - Street 1:431 CLAYPOOL BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-8732
Mailing Address - Country:US
Mailing Address - Phone:270-791-8189
Mailing Address - Fax:
Practice Address - Street 1:5966 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-0387
Practice Address - Country:US
Practice Address - Phone:270-791-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710028700Medicaid