Provider Demographics
NPI:1407999295
Name:ST. CLAIRE MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. CLAIRE MEDICAL CENTER
Other - Org Name:ST CLAIRE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:606-783-6502
Mailing Address - Street 1:234 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1194
Mailing Address - Country:US
Mailing Address - Phone:606-780-5330
Mailing Address - Fax:606-783-6869
Practice Address - Street 1:555 W SUN ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1563
Practice Address - Country:US
Practice Address - Phone:606-783-6805
Practice Address - Fax:606-783-6869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CLAIRE MEDICAL CENTER DBA ST. CLAIRE COUNSELING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY78103T00000X
KY8251041C0700X
KY7541041C0700X
KY313442084P0800X
KY220712084P0800X
KY246392084P0800X
KY1779P363LF0000X
KY3006694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100086290Medicaid
KY65942831Medicaid
KY89900328Medicaid
KY5970OtherMEDICARE PTAN
KY82900200Medicaid