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NPI Code Detail

MEDICARE: PURPOSE DRIVEN INTERVENTION SERVICES

MEDICARE: PURPOSE DRIVEN INTERVENTION SERVICES
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) Counselor
2101YP2500XProfessional Counselor
3171M00000XCase Manager/Care Coordinator
4175T00000XPeer Specialist
5207RA0401XAddiction Medicine (Internal Medicine) Physician
6363LP0808XPsychiatric/Mental Health Nurse Practitioner
7106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1689488421
Entity Type Code : Organization
Provider Name (Legal Business Name) : PURPOSE DRIVEN INTERVENTION SERVICES
Provider Business Mailing Address
First Line : 9575 KY HWY 122 STE 6
Second Line : ST 7
City : EAST MCDOWELL
State : KY
Zip : 41647
Country : US
Telephone Number : 606-359-0700
Fax Number :
Provider Business Practice Location Address
First Line : 9575 KY HWY 122 STE 6
Second Line : ST 7
City : EAST MCDOWELL
State : KY
Zip : 41647
Country : US
Telephone Number : 606-359-0700
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SAMANTHA STUMBO
Credential : LMFT
Telephone Number : 606-359-0700
Provider Enumeration Date : 02/03/2025
Last Update Date : 05/05/2025

Similar Medicare Providers

1184436016 — HANNAH ADAMS LPCA
Practice Location Address:
9575 KY HWY 122 STE 6 , ST 6
EAST MCDOWELL, KY
41647
Practice Phone: 606-949-1623
Practice Fax:
1922898337 — PURPOSE DRIVEN SUPPORT SERVICES
Practice Location Address:
9575 KY HWY 122 STE 6
EAST MCDOWELL, KY
41647
Practice Phone: 606-359-0700
Practice Fax:
1437949849 — PURPOSE DRIVEN SUPPORT SERVICES
Practice Location Address:
9575 KY HWY 122 STE 6
EAST MCDOWELL, KY
41647
Practice Phone: 606-359-0700
Practice Fax:
1780209692 — PURPOSE DRIVEN SUPPORT SERVICES
Practice Location Address:
9575 KY HWY 122 , SUITE 6
EAST MC DOWELL, KY
41647-4164
Practice Phone: 606-949-1623
Practice Fax:
1720091770 — MS. CLARITA V VICHER MD
Practice Location Address:
9879 KY RT 122 HOSPITAL DRIVE , SUITE 138
MCDOWELL, KY
41647-0595
Practice Phone: 606-377-2135
Practice Fax:
1912071382 — MCDOWELL PROFESSIONAL PHARMACY INC
Practice Location Address:
9549 KY HWY 122
MCDOWELL, KY
41647-0700
Practice Phone: 606-377-1088
Practice Fax: 606-377-2626

Directions to “PURPOSE DRIVEN INTERVENTION SERVICES ” Practice Location

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