Provider Demographics
NPI:1174260079
Name:TRIPLE CROWN COUNSELING
Entity Type:Organization
Organization Name:TRIPLE CROWN COUNSELING
Other - Org Name:SHANNON MCMILLAN
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL BILLER AND CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-931-4065
Mailing Address - Street 1:105 LYNDON LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5550
Mailing Address - Country:US
Mailing Address - Phone:502-509-3178
Mailing Address - Fax:502-509-0249
Practice Address - Street 1:105 LYNDON LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5550
Practice Address - Country:US
Practice Address - Phone:502-509-3178
Practice Address - Fax:502-509-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-12
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100779020Medicaid