Provider Demographics
NPI:1467819243
Name:MASSEY COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:MASSEY COUNSELING SERVICES LLC
Other - Org Name:BENNY MASSEY LPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:VERNELL
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MED LPCC
Authorized Official - Phone:502-377-3777
Mailing Address - Street 1:2210 GOLDSMITH LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1038
Mailing Address - Country:US
Mailing Address - Phone:502-377-3777
Mailing Address - Fax:502-415-7419
Practice Address - Street 1:2210 GOLDSMITH LN
Practice Address - Street 2:SUITE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1038
Practice Address - Country:US
Practice Address - Phone:502-377-3777
Practice Address - Fax:502-415-7419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENNY MASSEY LPCC PRIVATE PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1565251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100266440Medicaid