| Bluegrass Professional Counseling, Llc | |
|
103 East South Street Munfordville KY 42765 | |
| (270) 696-3181 | |
| (877) 308-1668 |
| Full Name | Bluegrass Professional Counseling, Llc |
|---|---|
| Speciality | Counselor |
| Location | 103 East South Street, Munfordville, Kentucky |
| Authorized Official Name and Position | Jan Hatcher (MANAGING EMPLOYEE) |
| Authorized Official Contact | 2706963181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluegrass Professional Counseling, Llc 103 E South St Munfordville KY 42765-9023 Ph: (270) 696-3181 | Bluegrass Professional Counseling, Llc 103 East South Street Munfordville KY 42765 Ph: (270) 696-3181 |
| NPI Number | 1063899789 |
|---|---|
| Provider Enumeration Date | 05/01/2015 |
| Last Update Date | 11/30/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 3476815085 |
|---|---|
| Medicare Enrollment ID | O20180320000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063899789 | NPI | - | NPPES |
| 7100326630 | Medicaid | KY | |
| 7100366710 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 00211339 (Kentucky) | Primary |
| 104100000X | Social Worker | 6908 (Kentucky) | Secondary |
| Provider Name | Shawn M Lanham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598273062 PECOS PAC ID: 7113280199 Enrollment ID: I20180405000775 |
| Provider Name | Ashley Michelle Foster-flynn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770119505 PECOS PAC ID: 3678934924 Enrollment ID: I20230802002678 |
| Provider Name | Robert R Cassman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316142151 PECOS PAC ID: 6901253947 Enrollment ID: I20231113001144 |
| Provider Name | Chonda Saettel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124664677 PECOS PAC ID: 7113366675 Enrollment ID: I20240416003801 |