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3333 Court St Ste 2 Catlettsburg KY 41129-1195 | |
| (606) 547-2262 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3333 Court St Ste 2, Catlettsburg, Kentucky |
| Authorized Official Name and Position | Rita Vaughn (OWNER) |
| Authorized Official Contact | 3049081056 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3333 Court St Ste 2 Catlettsburg KY 41129-1195 Ph: () - | 3333 Court St Ste 2 Catlettsburg KY 41129-1195 Ph: (606) 547-2262 |
| NPI Number | 1922707579 |
|---|---|
| Provider Enumeration Date | 03/02/2023 |
| Last Update Date | 10/01/2024 |
| Certification Date | 10/01/2024 |
| Medicare PECOS PAC ID | 8921539008 |
|---|---|
| Medicare Enrollment ID | O20240930003299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922707579 | NPI | - | NPPES |
| 1263251 | Other | KY | ORGANIZATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Rita Vaughn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104047000 PECOS PAC ID: 1052850765 Enrollment ID: I20240906002416 |
Elysian Wellness Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3237 Camelot Dr, Catlettsburg, KY 41129 Phone: 606-615-6989 | |