MEDICARE: BLUEGRASS COUNSELING & TRAUMA 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	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	:	1366197147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS COUNSELING & TRAUMA SERVICES

Provider Business Mailing Address
First Line	:	503 DARBY CREEK RD STE C
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1603
Country	:	US
Telephone Number	:	859-368-2567
Fax Number	:	859-788-3905

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	:	859-368-2567
Fax Number	:	859-788-3905

Authorized Official
Title or Position	:	CONTRACTING DIRECTOR
Name	:	CRYSTAL STAPLETON
Credential	:
Telephone Number	:	270-380-1093

Provider Enumeration Date	:	02/19/2022
Last Update Date	:	04/09/2024

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