Basic Information
Provider Information
NPI: 1508976192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STILES
FirstName: ALICE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 267 HICKORY LN
Address2:  
City: BOWLING GREEN
State: KY
PostalCode: 421017830
CountryCode: US
TelephoneNumber: 2709015000
FaxNumber: 2708425268
Practice Location
Address1: 640 WRIGHT AVE
Address2:  
City: BOWLING GREEN
State: KY
PostalCode: 421031679
CountryCode: US
TelephoneNumber: 2709015000
FaxNumber: 2707825927
Other Information
ProviderEnumerationDate: 08/30/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X1757KYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

ID Information
IDTypeStateIssuerDescription
3060401105KY MEDICAID


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