Provider Demographics
NPI:1780822551
Name:IDEALS KENTUCKY
Entity Type:Organization
Organization Name:IDEALS KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DE
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:859-806-1975
Mailing Address - Street 1:828 LANE ALLEN RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3658
Mailing Address - Country:US
Mailing Address - Phone:859-806-1975
Mailing Address - Fax:
Practice Address - Street 1:813 HILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2458
Practice Address - Country:US
Practice Address - Phone:502-227-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty