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8134 New Lagrange Road Suite 100 Louisville KY 40222 | |
| (502) 767-0415 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 8134 New Lagrange Road Suite 100, Louisville, Kentucky |
| Authorized Official Name and Position | Henry Lucas (OWNER) |
| Authorized Official Contact | 5027670415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8134 New Lagrange Road Suite 100 Louisville KY 40222-1245 Ph: (502) 767-0415 | 8134 New Lagrange Road Suite 100 Louisville KY 40222 Ph: (502) 767-0415 |
| NPI Number | 1740881507 |
|---|---|
| Provider Enumeration Date | 11/06/2020 |
| Last Update Date | 11/16/2023 |
| Certification Date | 11/16/2023 |
| Medicare PECOS PAC ID | 6800282971 |
|---|---|
| Medicare Enrollment ID | O20220330001261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740881507 | NPI | - | NPPES |
| 7100726990 | Medicaid | KY |
| Provider Name | Holly Sumner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417387242 PECOS PAC ID: 0042504714 Enrollment ID: I20160803003105 |
| Provider Name | Jessica A. Weinstein |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104235597 PECOS PAC ID: 9739439746 Enrollment ID: I20180912000551 |
| Provider Name | Angela M Hogan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225702483 PECOS PAC ID: 3274926076 Enrollment ID: I20220129000355 |
| Provider Name | Henry Lucas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336573773 PECOS PAC ID: 7618363797 Enrollment ID: I20220330001473 |
| Provider Name | Allison Scott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265176077 PECOS PAC ID: 5294112330 Enrollment ID: I20220511001974 |
| Provider Name | Denise Stephens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295133304 PECOS PAC ID: 5991185548 Enrollment ID: I20220629002013 |
| Provider Name | Jenifer Jimison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558932145 PECOS PAC ID: 4183005853 Enrollment ID: I20220713001875 |
| Provider Name | Christie L Hines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295267904 PECOS PAC ID: 2860873247 Enrollment ID: I20220715002249 |
| Provider Name | Daleigh Louise Kranz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922746700 PECOS PAC ID: 3577001569 Enrollment ID: I20240821004439 |
| Provider Name | Mcclain Leeds Owens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881328383 PECOS PAC ID: 8628501012 Enrollment ID: I20241023003185 |
| Provider Name | Ronald Eugene Hager |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104997477 PECOS PAC ID: 9436247855 Enrollment ID: I20241111000712 |
| Provider Name | Rachel Elizabeth Wells |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1598418741 PECOS PAC ID: 6901330893 Enrollment ID: I20241114003241 |
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