Provider Demographics
NPI:1508497165
Name:KUHN, STACY (LCADC, CRC, LPCA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:KUHN
Suffix:
Gender:F
Credentials:LCADC, CRC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 LATON TURNER RD
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:KY
Mailing Address - Zip Code:42784-9507
Mailing Address - Country:US
Mailing Address - Phone:270-272-6127
Mailing Address - Fax:
Practice Address - Street 1:103 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9023
Practice Address - Country:US
Practice Address - Phone:270-272-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165240101YA0400X
KY274983101YM0800X
KY564045225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100648100Medicaid