Provider Demographics
NPI:1811656226
Name:JAYLEE AWAKENED MINISTRIES, LLC
Entity type:Organization
Organization Name:JAYLEE AWAKENED MINISTRIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:859-279-2949
Mailing Address - Street 1:169 E REYNOLDS RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1272
Mailing Address - Country:US
Mailing Address - Phone:859-279-2949
Mailing Address - Fax:502-323-0749
Practice Address - Street 1:169 E REYNOLDS RD STE 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1270
Practice Address - Country:US
Practice Address - Phone:859-279-2949
Practice Address - Fax:502-323-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100786330Medicaid