| 897 Mount Rushmore Drive | |
|
106 E Main St Richmond KY 40475-1647 | |
| (859) 951-4440 | |
| Not Available |
| Full Name | 897 Mount Rushmore Drive |
|---|---|
| Speciality | Social Worker |
| Location | 106 E Main St, Richmond, Kentucky |
| Authorized Official Name and Position | Stacy Lynn Harris (OWNER/MANAGER) |
| Authorized Official Contact | 6067764741 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 897 Mount Rushmore Drive 897 Mount Rushmore Dr Richmond KY 40475-8760 Ph: (606) 776-4741 | 897 Mount Rushmore Drive 106 E Main St Richmond KY 40475-1647 Ph: (859) 951-4440 |
| NPI Number | 1891353504 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 02/15/2022 |
| Certification Date | 02/15/2022 |
| Medicare PECOS PAC ID | 1052718590 |
|---|---|
| Medicare Enrollment ID | O20210924002754 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891353504 | NPI | - | NPPES |
| 7100282850 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Stacy Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457401374 PECOS PAC ID: 8022394634 Enrollment ID: I20170414000387 |
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