| A Center 4 Change | |
|
5900 Us 60 W Suite B Ashland KY 41101 | |
| (606) 393-5586 | |
| Not Available |
| Full Name | A Center 4 Change |
|---|---|
| Speciality | Psychologist |
| Location | 5900 Us 60 W, Ashland, Kentucky |
| Authorized Official Name and Position | Tonya Michelle Judd (CO OWNER) |
| Authorized Official Contact | 6063935586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Center 4 Change Po Box 5074 Ashland KY 41105-5074 Ph: (606) 393-5586 | A Center 4 Change 5900 Us 60 W Suite B Ashland KY 41101 Ph: (606) 393-5586 |
| NPI Number | 1033572540 |
|---|---|
| Provider Enumeration Date | 04/01/2016 |
| Last Update Date | 04/01/2016 |
| Medicare PECOS PAC ID | 7517255383 |
|---|---|
| Medicare Enrollment ID | O20161011000951 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033572540 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 0138351016 (Kentucky) | Primary |
| Provider Name | Terry J King |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1841616273 PECOS PAC ID: 6103133558 Enrollment ID: I20150916003287 |
| Provider Name | Philip Bloomer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265864425 PECOS PAC ID: 4486947033 Enrollment ID: I20160720001281 |
| Provider Name | Melodee Bly Thacker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912350513 PECOS PAC ID: 2365728177 Enrollment ID: I20170410002577 |
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