Provider Demographics
NPI:1366197147
Name:BLUEGRASS COUNSELING & TRAUMA SERVICES
Entity type:Organization
Organization Name:BLUEGRASS COUNSELING & TRAUMA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-380-1093
Mailing Address - Street 1:503 DARBY CREEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1603
Mailing Address - Country:US
Mailing Address - Phone:859-368-2567
Mailing Address - Fax:859-788-3905
Practice Address - Street 1:503 DARBY CREEK RD STE C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1603
Practice Address - Country:US
Practice Address - Phone:859-368-2567
Practice Address - Fax:859-788-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-19
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100808560Medicaid