| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 208 Kidd Dr, Berea, Kentucky |
| Authorized Official Name and Position | Lisa Roseanne Parsons (OWNER) |
| Authorized Official Contact | 8599857862 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 802 Berea KY 40403-0802 Ph: (859) 428-7862 | 208 Kidd Dr Berea KY 40403-9593 Ph: (859) 428-7862 |
| NPI Number | 1376911008 |
|---|---|
| Provider Enumeration Date | 09/11/2015 |
| Last Update Date | 09/12/2023 |
| Certification Date | 09/12/2023 |
| Medicare PECOS PAC ID | 1557744984 |
|---|---|
| Medicare Enrollment ID | O20220818001012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376911008 | NPI | - | NPPES |
| 7100484060 | Medicaid | KY |
| Provider Name | Meagan Ott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942855440 PECOS PAC ID: 9537565353 Enrollment ID: I20210902001417 |
| Provider Name | Linda L Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881379006 PECOS PAC ID: 8921469412 Enrollment ID: I20230731003728 |
| Provider Name | Brittany Alexis Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275070658 PECOS PAC ID: 1153773023 Enrollment ID: I20240116002790 |
| Provider Name | Kelly Deaton Tolliver |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417295312 PECOS PAC ID: 9931551298 Enrollment ID: I20240123000759 |
| Provider Name | Lisa Roseanne Parsons |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124364625 PECOS PAC ID: 7810370244 Enrollment ID: I20240124001462 |
| Provider Name | Amy Renee Oliver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700647955 PECOS PAC ID: 0345684411 Enrollment ID: I20240216000352 |
| Provider Name | Laura Weitkamp |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083182570 PECOS PAC ID: 4284078148 Enrollment ID: I20240219002377 |
| Provider Name | Elizabeth Rae Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821601337 PECOS PAC ID: 7719321595 Enrollment ID: I20240220003424 |
| Provider Name | Taylor Frances Speaks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235705104 PECOS PAC ID: 8325482102 Enrollment ID: I20240220003523 |
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