Provider Demographics
NPI:1356677033
Name:ALLYSON BLYTHE, LLC
Entity Type:Organization
Organization Name:ALLYSON BLYTHE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-341-7773
Mailing Address - Street 1:7430 US HIGHWAY 42 STE 217
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1992
Mailing Address - Country:US
Mailing Address - Phone:859-341-7773
Mailing Address - Fax:859-341-0376
Practice Address - Street 1:7430 US HIGHWAY 42 STE 217
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1992
Practice Address - Country:US
Practice Address - Phone:859-341-7773
Practice Address - Fax:859-341-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
KY1304251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty