Healthcare Provider Details

I. General information

NPI: 1356677033
Provider Name (Legal Business Name): ALLYSON BLYTHE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 US HIGHWAY 42 STE 217
FLORENCE KY
41042-1992
US

IV. Provider business mailing address

7430 US HIGHWAY 42 STE 217
FLORENCE KY
41042-1992
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-7773
  • Fax: 859-341-0376
Mailing address:
  • Phone: 859-341-7773
  • Fax: 859-341-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1304
License Number StateKY

VIII. Authorized Official

Name: MS. ALLYSON R BLYTHE
Title or Position: OWNER
Credential: LCSW
Phone: 859-341-7773