Healthcare Provider Details

I. General information

NPI: 1417374943
Provider Name (Legal Business Name): ESSENTIAL HEALING IOP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 ALYSHEBA WAY 1001
LEXINGTON KY
40509-2282
US

IV. Provider business mailing address

1795 ALYSHEBA WAY 1001
LEXINGTON KY
40509-2282
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateKY
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY
# 10
Primary TaxonomyN
Taxonomy Code176P00000X
TaxonomyFuneral Director
License Number
License Number StateKY
# 11
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateKY

VIII. Authorized Official

Name: STEVANIE SMITH
Title or Position: PROGRAM DIRECTOR/THERAPIST
Credential: M.ED., NCC, LPCC
Phone: 859-687-0416