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General NPI Number Information
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NPI Number | 1558679480
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Entity Type | Organization
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Legal Business Name | TIME OUT COMMUNITY COUNSELING AND CORRECTIONAL SERVICES, LLC
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1502 PARK CITY GLASGOW RD
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City | GLASGOW
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State | KY
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Zip | 42141-7209
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Country | US
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Telephone | 270-678-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 102 W PUBLIC SQ
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City | SCOTTSVILLE
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State | KY
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Zip | 42164-1175
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Country | US
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Telephone | 270-237-3463
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Fax | 270-237-3464
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Authorized Official
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Title or Position | OFFICE MANAGER/EDUCATOR
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Name | MRS. ANGELA SUE FARLEY
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Credential | RN
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Telephone | 270-237-3463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 810288
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 1107277
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 1107277
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1107277
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License Number State | KY
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Taxonomy #5
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Taxonomy Code | 163WC1600X
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Taxonomy Name | Continuing Education/Staff Development Registered Nurse
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License Number | 1107277
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License Number State | KY
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Taxonomy #6
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0531
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License Number State | KY
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