Healthcare Provider Details

I. General information

NPI: 1871197764
Provider Name (Legal Business Name): HEAVEN LEIGH SUTTON TCM,CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date: 05/19/2026
Reactivation Date: 07/22/2026

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

IV. Provider business mailing address

1240 WOODLAND DRIVE
ELIZABETHTOWN KY
42701
US

V. Phone/Fax

Practice location:
  • Phone: 606-639-0938
  • Fax: 859-813-5394
Mailing address:
  • Phone: 502-264-7744
  • Fax: 270-900-1519

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 Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: