Provider Demographics
NPI:1952780074
Name:BLUEGRASS COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:BLUEGRASS COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTISS
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:502-472-4232
Mailing Address - Street 1:4400 BRECKENRIDGE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-4082
Mailing Address - Country:US
Mailing Address - Phone:502-777-3516
Mailing Address - Fax:844-655-2282
Practice Address - Street 1:4400 BRECKENRIDGE LN STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4082
Practice Address - Country:US
Practice Address - Phone:502-777-3516
Practice Address - Fax:844-655-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty