MEDICARE: RACHEL GREENWELL T-CADC, TCM, APSS

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	171M00000X	Case Manager/Care Coordinator	202232	KY
2	175T00000X	Peer Specialist	279087	KY
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	279087	KY

General Provider Information

NPI Number	:	1609563006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL GREENWELL T-CADC, TCM, APSS

Provider Business Mailing Address
First Line	:	PO BOX 1484
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-1484
Country	:	US
Telephone Number	:	502-222-2389
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 CATHY WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-3286
Country	:	US
Telephone Number	:	502-381-5208
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/19/2023

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