Healthcare Provider Details

I. General information

NPI: 1366257867
Provider Name (Legal Business Name): MATTHEW RULE LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 OLD SOLDIER CREEK RD
KIRKSEY KY
42054-9117
US

IV. Provider business mailing address

1250 OLD SOLDIER CREEK RD
KIRKSEY KY
42054-9117
US

V. Phone/Fax

Practice location:
  • Phone: 270-489-2594
  • Fax: 270-489-2574
Mailing address:
  • Phone: 270-489-2594
  • Fax: 270-489-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number295405
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number295405
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: