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NPI Code Detail

MEDICARE: TATYANA LATRICE SPEARS LCADC

MEDICARE: TATYANA LATRICE SPEARS 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
1101YA0400XAddiction (Substance Use Disorder) Counselor289741KY

General Provider Information

NPI Number : 1609610674
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATYANA LATRICE SPEARS LCADC
Provider Business Mailing Address
First Line : 2901 PIGEON ROOST RD
Second Line :
City : RUSH
State : KY
Zip : 41168-8132
Country : US
Telephone Number : 606-928-6648
Fax Number : 606-928-1056
Provider Business Practice Location Address
First Line : 10 TOWN CENTER BLVD STE 2
Second Line :
City : CRESTVIEW HILLS
State : KY
Zip : 41017-2416
Country : US
Telephone Number : 859-360-6120
Fax Number : 606-547-4253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2024
Last Update Date : 10/22/2025

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Directions to “ TATYANA LATRICE SPEARS LCADC” Practice Location

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