Vanquish LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

VANQUISH LLC

Practice address

1005 Rose Hill Cir
Hueytown, AL 35023-3660

Phone

(205) 386-0809

NPI assigned

Jun 6, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kristie Pettway, MS, ALCNPI 1255041331

Title

Owner

Phone

(205) 386-0809

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kristie Pettway, MS, ALC

  • Counselor
  • Hueytown, AL
  • NPI 1255041331

  Multi-Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1740974302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 ROSE HILL CIR",
            "city": "HUEYTOWN",
            "state": "AL",
            "postal_code": "350233660",
            "telephone_number": "205-386-0809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 ROSE HILL CIR",
            "city": "HUEYTOWN",
            "state": "AL",
            "postal_code": "350233660",
            "telephone_number": "205-386-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANQUISH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "PETTWAY",
        "authorized_official_first_name": "KRISTIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "205-386-0809",
        "authorized_official_credential": "MS, ALC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Hueytown, AL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.