Healthcare Provider Details

I. General information

NPI: 1578234449
Provider Name (Legal Business Name): BLUEGRASS BEHAVIORAL HEALTH & CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 08/13/2022
Certification Date: 08/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DOE RUN DR STE 5
MT STERLING KY
40353-9097
US

IV. Provider business mailing address

601 DOE RUN DR STE 5
MT STERLING KY
40353-9097
US

V. Phone/Fax

Practice location:
  • Phone: 859-432-3055
  • Fax: 859-432-3044
Mailing address:
  • Phone: 859-432-3055
  • Fax: 859-432-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAWNDA CARTER
Title or Position: CEO
Credential: APRN, PMHNP-BC
Phone: 859-274-6414