Provider Demographics
NPI:1780209692
Name:PURPOSE DRIVEN SUPPORT SERVICES
Entity Type:Organization
Organization Name:PURPOSE DRIVEN SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ED/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, TCADC
Authorized Official - Phone:606-359-0700
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0041
Mailing Address - Country:US
Mailing Address - Phone:063-590-7006
Mailing Address - Fax:
Practice Address - Street 1:9575 KY HWY 122
Practice Address - Street 2:SUITE 6
Practice Address - City:EAST MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-4164
Practice Address - Country:US
Practice Address - Phone:606-949-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100674370Medicaid