Healthcare Provider Details

I. General information

NPI: 1801592910
Provider Name (Legal Business Name): FRANKFORT AREA CHILDREN'S COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 STEELE ST
FRANKFORT KY
40601-2744
US

IV. Provider business mailing address

208 STEELE ST
FRANKFORT KY
40601-2744
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-3495
  • Fax:
Mailing address:
  • Phone: 502-875-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLY L DYCUS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC-S
Phone: 502-875-3495