MEDICARE: TROY MANSFIELD CADC, CSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		KY

General Provider Information

NPI Number	:	1255287322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY MANSFIELD CADC, CSW

Provider Business Mailing Address
First Line	:	120 BARBERRY LN
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-9572
Country	:	US
Telephone Number	:	859-756-5006
Fax Number	:	859-985-9665

Provider Business Practice Location Address
First Line	:	1000 ACE DR
Second Line	:
City	:	BEREA
State	:	KY
Zip	:	40403-1327
Country	:	US
Telephone Number	:	859-756-5006
Fax Number	:	859-985-9665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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