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4414 Old Lagrange Rd Buckner KY 40010-9547 | |
| (502) 222-2389 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 4414 Old Lagrange Rd, Buckner, Kentucky |
| Authorized Official Name and Position | Nina J Roy (RECONCILIATION DIRECTOR) |
| Authorized Official Contact | 2705854306 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1484 Crestwood KY 40014-1484 Ph: () - | 4414 Old Lagrange Rd Buckner KY 40010-9547 Ph: (502) 222-2389 |
| NPI Number | 1013662717 |
|---|---|
| Provider Enumeration Date | 02/21/2022 |
| Last Update Date | 12/12/2023 |
| Certification Date | 12/12/2023 |
| Medicare PECOS PAC ID | 2860840493 |
|---|---|
| Medicare Enrollment ID | O20231121000960 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013662717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
| 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 | Erik Plymale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265852123 PECOS PAC ID: 7719425719 Enrollment ID: I20240821000512 |
| Provider Name | Scottye Sparks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447633839 PECOS PAC ID: 9739628728 Enrollment ID: I20240821005010 |
| Provider Name | Kathryn Blair Plymale |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285973164 PECOS PAC ID: 3678012572 Enrollment ID: I20240822004610 |