Healthcare Provider Details

I. General information

NPI: 1780092957
Provider Name (Legal Business Name): EARLY INTERVENTION AND CONSULTATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 S MAIN ST STE B
LEITCHFIELD KY
42754
US

IV. Provider business mailing address

635 S MAIN ST STE B
LEITCHFIELD KY
42754-1056
US

V. Phone/Fax

Practice location:
  • Phone: 270-287-0656
  • Fax: 270-230-0328
Mailing address:
  • Phone: 270-287-0656
  • Fax: 270-230-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number800280
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number800280
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LASHELL ROBIN LASHLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A.E., M.A.S.E.,
Phone: 270-868-0089