Provider Demographics
NPI:1225576044
Name:CASE MANAGEMENT AND COUNSELING SERVICES OF KENTUCKY, LLC
Entity Type:Organization
Organization Name:CASE MANAGEMENT AND COUNSELING SERVICES OF KENTUCKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC, LCADC
Authorized Official - Phone:859-492-8509
Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-687-0416
Mailing Address - Fax:859-353-4200
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:SUITE 1001
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2280
Practice Address - Country:US
Practice Address - Phone:859-687-0416
Practice Address - Fax:859-353-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171070101YA0400X
KY164125101YP2500X
KY171M00000X
KY46380207RA0401X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty