MEDICARE: CALEB PATE LCSW, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	164872	KY
2	1041C0700X	Clinical Social Worker	260140	KY

General Provider Information

NPI Number	:	1669744561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB PATE LCSW, LCADC

Provider Business Mailing Address
First Line	:	237 SAINT REGIS DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-6317
Country	:	US
Telephone Number	:	502-797-6503
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 SAINT REGIS DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-6317
Country	:	US
Telephone Number	:	502-797-6503
Fax Number	:

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

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	04/13/2025

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