Provider Demographics
NPI:1780148353
Name:SOUTHLAND CHILD, ADULT, AND FAMILY COUNSELING
Entity type:Organization
Organization Name:SOUTHLAND CHILD, ADULT, AND FAMILY COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LCSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-285-2959
Mailing Address - Street 1:3320 CLAYS MILL RD STE 109
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3484
Mailing Address - Country:US
Mailing Address - Phone:859-285-2959
Mailing Address - Fax:859-838-1092
Practice Address - Street 1:3320 CLAYS MILL RD STE 109
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3484
Practice Address - Country:US
Practice Address - Phone:859-285-2959
Practice Address - Fax:859-838-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1669512901Medicaid