Healthcare Provider Details

I. General information

NPI: 1598972762
Provider Name (Legal Business Name): CHILD AND FAMILY SERVICE COORDINATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 ALVATON RD
ALVATON KY
42122-9657
US

IV. Provider business mailing address

9940 ALVATON RD
ALVATON KY
42122-9657
US

V. Phone/Fax

Practice location:
  • Phone: 270-746-6600
  • Fax: 270-842-9008
Mailing address:
  • Phone: 270-746-6600
  • Fax: 270-842-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number29200425
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number29100427
License Number StateKY

VIII. Authorized Official

Name: JAN TRABUE
Title or Position: CEO
Credential: LPCC
Phone: 270-746-6600