Healthcare Provider Details

I. General information

NPI: 1285562553
Provider Name (Legal Business Name): CCMH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 11TH ST
CARROLLTON KY
41008-1435
US

IV. Provider business mailing address

309 11TH ST
CARROLLTON KY
41008-1435
US

V. Phone/Fax

Practice location:
  • Phone: 502-732-6420
  • Fax: 502-732-6424
Mailing address:
  • Phone: 502-732-6420
  • Fax: 502-732-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHEILA TOMLINSON
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential:
Phone: 502-732-3243