MEDICARE: BLUEGRASS RELATIONAL PSYCHOTHERAPY, LLC

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	:	1518817147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS RELATIONAL PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	2825 PEAKS MILL DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-8876
Country	:	US
Telephone Number	:	859-533-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 E REYNOLDS RD STE 160
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1363
Country	:	US
Telephone Number	:	859-208-0003
Fax Number	:

Authorized Official
Title or Position	:	LCSW, OWNER
Name	:	TRAVIS NEACE
Credential	:	LCSW
Telephone Number	:	859-208-0003

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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