Healthcare Provider Details

I. General information

NPI: 1114525946
Provider Name (Legal Business Name): JONATHAN TYLER HUGHES TCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 LOUISVILLE RD STE 501
FRANKFORT KY
40601-6140
US

IV. Provider business mailing address

1121 LOUISVILLE RD STE 501
FRANKFORT KY
40601-6140
US

V. Phone/Fax

Practice location:
  • Phone: 502-661-1444
  • Fax:
Mailing address:
  • Phone: 502-661-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: