Healthcare Provider Details

I. General information

NPI: 1053060210
Provider Name (Legal Business Name): RECAPTURE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W LEXINGTON AVE
WINCHESTER KY
40391-1241
US

IV. Provider business mailing address

6428 VETERANS MEMORIAL HWY
SHARPSBURG KY
40374-8001
US

V. Phone/Fax

Practice location:
  • Phone: 859-644-5046
  • Fax:
Mailing address:
  • Phone: 859-585-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LORI LYNETTE COUCH
Title or Position: OWNER
Credential:
Phone: 859-644-5046