MEDICARE: JAYLEE AWAKENED MINISTRIES, LLC

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	106H00000X	Marriage & Family Therapist
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811656226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYLEE AWAKENED MINISTRIES, LLC

Provider Business Mailing Address
First Line	:	169 E REYNOLDS RD STE 100A
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1272
Country	:	US
Telephone Number	:	859-279-2949
Fax Number	:	502-323-0749

Provider Business Practice Location Address
First Line	:	169 E REYNOLDS RD STE 101
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-1270
Country	:	US
Telephone Number	:	859-279-2949
Fax Number	:	502-323-0749

Authorized Official
Title or Position	:	OWNER AND THERAPIST
Name	:	JAYLEE CUNNINGHAM
Credential	:	MA, LMFT
Telephone Number	:	859-279-2949

Provider Enumeration Date	:	12/13/2021
Last Update Date	:	09/02/2025

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