MEDICARE: OPEN DOORS COUNSELING CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator
3	103T00000X	Psychologist
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	1041C0700X	Clinical Social Worker
6	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265072219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOORS COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	210 E HIGH ST UNIT 394
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40588-0849
Country	:	US
Telephone Number	:	606-776-6185
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 DARBY CREEK RD STE C
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1603
Country	:	US
Telephone Number	:	606-776-6185
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING/ BILLING MANAGER
Name	:	DEREK PICKLESIMER
Credential	:	MBA
Telephone Number	:	859-300-1437

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	02/02/2026

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