MEDICARE: JANEAN TINSLEY LCADC

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	101YP1600X	Pastoral Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	164507	KY

General Provider Information

NPI Number	:	1548509623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEAN TINSLEY LCADC

Provider Business Mailing Address
First Line	:	120 BRETT CHASE STE A
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-5766
Country	:	US
Telephone Number	:	270-260-0096
Fax Number	:	270-229-6077

Provider Business Practice Location Address
First Line	:	120 BRETT CHASE STE A
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-5766
Country	:	US
Telephone Number	:	270-260-0096
Fax Number	:

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

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	08/03/2023

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Directions to “ JANEAN TINSLEY LCADC” Practice Location

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