Provider Demographics
NPI:1457247827
Name:BLUEGRASS COUNSELING AND PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:BLUEGRASS COUNSELING AND PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:859-302-0923
Mailing Address - Street 1:105 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7707
Mailing Address - Country:US
Mailing Address - Phone:859-302-0923
Mailing Address - Fax:
Practice Address - Street 1:322 W WATER ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3503
Practice Address - Country:US
Practice Address - Phone:859-302-0923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty