Healthcare Provider Details

I. General information

NPI: 1225576044
Provider Name (Legal Business Name): CASE MANAGEMENT AND COUNSELING SERVICES OF KENTUCKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 ALYSHEBA WAY SUITE 1001
LEXINGTON KY
40509-2280
US

IV. Provider business mailing address

1795 ALYSHEBA WAY SUITE 1001
LEXINGTON KY
40509-2280
US

V. Phone/Fax

Practice location:
  • Phone: 859-687-0416
  • Fax: 859-353-4200
Mailing address:
  • Phone: 859-687-0416
  • Fax: 859-353-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number171070
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number164125
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number46380
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVANIE SMITH
Title or Position: PROGRAM DIRECTOR
Credential: M.ED., LPCC, LCADC
Phone: 859-492-8509