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NPI Code Detail

MEDICARE: KILGORE SAMARITAN COUNSELING CENTER

MEDICARE: KILGORE SAMARITAN COUNSELING CENTER
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
1103TC0700XClinical Psychologist
2104100000XSocial Worker
3106H00000XMarriage & Family Therapist106665KY
4106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1831294586
Entity Type Code : Organization
Provider Name (Legal Business Name) : KILGORE SAMARITAN COUNSELING CENTER
Provider Business Mailing Address
First Line : 918 ORMSBY LN.
Second Line :
City : LOUISVILLE
State : KY
Zip : 40242-4536
Country : US
Telephone Number : 502-327-4622
Fax Number : 502-327-4675
Provider Business Practice Location Address
First Line : 918 ORMSBY LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40242-4536
Country : US
Telephone Number : 502-327-4622
Fax Number : 502-327-4675
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MR. BARRY G WINSTEAD
Credential : M.DIV, MA, LMFT
Telephone Number : 502-327-4622
Provider Enumeration Date : 09/14/2006
Last Update Date : 07/21/2022

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