Healthcare Provider Details

I. General information

NPI: 1811339914
Provider Name (Legal Business Name): KY STEPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3960
US

IV. Provider business mailing address

489 MATLOCK RD
BOWLING GREEN KY
42104-7407
US

V. Phone/Fax

Practice location:
  • Phone: 270-938-1020
  • Fax: 270-938-1018
Mailing address:
  • Phone: 270-320-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0832605
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0832605
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0832605
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0832605
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 10
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 11
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0832605
License Number StateKY
# 12
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0832605
License Number StateKY
# 13
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 14
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0832605
License Number StateKY
# 15
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number0832605
License Number StateKY

VIII. Authorized Official

Name: MR. DANIEL AGYEI BOAMAH
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, MSSW, LCSW
Phone: 270-320-1101