Provider Demographics
NPI:1609641919
Name:KENTUCKY TRAUMA THERAPISTS, LLC
Entity Type:Organization
Organization Name:KENTUCKY TRAUMA THERAPISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY SUPPORT ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:364-203-9250
Mailing Address - Street 1:661 US 31W BYP STE G
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4968
Mailing Address - Country:US
Mailing Address - Phone:364-203-9250
Mailing Address - Fax:
Practice Address - Street 1:661 US 31W BYP STE G
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4968
Practice Address - Country:US
Practice Address - Phone:364-203-9250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty