MEDICARE: BLUEGRASS MIND COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174455083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS MIND COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2601 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1316
Country	:	US
Telephone Number	:	270-313-5395
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 NEW HARTFORD RD
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42303-1316
Country	:	US
Telephone Number	:	270-313-5395
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	APRIL COOPER
Credential	:	LCSW
Telephone Number	:	270-313-5395

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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