| Kentucky River Community Care, Inc | |
|
115 Rockwood Ln Hazard KY 41701-9415 | |
| (606) 436-4071 | |
| (606) 436-5797 |
| Full Name | Kentucky River Community Care, Inc |
|---|---|
| Speciality | Counselor |
| Location | 115 Rockwood Ln, Hazard, Kentucky |
| Authorized Official Name and Position | Marcia Adams (CFO) |
| Authorized Official Contact | 6066664351 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentucky River Community Care, Inc 115 Rockwood Ln Hazard KY 41701-9415 Ph: (606) 436-5761 | Kentucky River Community Care, Inc 115 Rockwood Ln Hazard KY 41701-9415 Ph: (606) 436-4071 |
| NPI Number | 1528017142 |
|---|---|
| Provider Enumeration Date | 05/09/2006 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Medicare PECOS PAC ID | 3870481229 |
|---|---|
| Medicare Enrollment ID | O20040308000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528017142 | NPI | - | NPPES |
| 30612022 | Medicaid | KY |
| Provider Name | Geraldo D Lima |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992831226 PECOS PAC ID: 7517851264 Enrollment ID: I20040212000248 |
| Provider Name | Roger D Coleman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609880822 PECOS PAC ID: 1254327836 Enrollment ID: I20040421000066 |
| Provider Name | Artie A Bates |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457344004 PECOS PAC ID: 7719974757 Enrollment ID: I20040429001347 |
| Provider Name | Robert Allan Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588658603 PECOS PAC ID: 2264468982 Enrollment ID: I20050714000266 |
| Provider Name | Sandra Faye Pratt |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1699769919 PECOS PAC ID: 4486669322 Enrollment ID: I20060214000019 |
| Provider Name | Jerry T Ward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962436832 PECOS PAC ID: 1759458078 Enrollment ID: I20080927000280 |
| Provider Name | Judy I Cattoi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356457188 PECOS PAC ID: 6305906884 Enrollment ID: I20081114000211 |
| Provider Name | Freida Eldridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902914211 PECOS PAC ID: 1153462320 Enrollment ID: I20100111000070 |
| Provider Name | Marissa E. Shih |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629165956 PECOS PAC ID: 2163553827 Enrollment ID: I20100624000882 |
| Provider Name | Polly J Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760793285 PECOS PAC ID: 8729112982 Enrollment ID: I20100810001024 |
| Provider Name | Robert Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306839782 PECOS PAC ID: 0042403065 Enrollment ID: I20101022000822 |
| Provider Name | Maudella G Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588920300 PECOS PAC ID: 1254586472 Enrollment ID: I20130219000267 |
| Provider Name | Stephanie Michelle Strand |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1457792533 PECOS PAC ID: 8820230717 Enrollment ID: I20130805000986 |
| Provider Name | Ernestine Tilley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710321195 PECOS PAC ID: 2961645049 Enrollment ID: I20130821000981 |
| Provider Name | Nebraska Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306239991 PECOS PAC ID: 5991006868 Enrollment ID: I20151217002167 |
| Provider Name | Jenna Patton |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1639414527 PECOS PAC ID: 9335446723 Enrollment ID: I20160330001414 |
| Provider Name | Michael L Ely |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669819421 PECOS PAC ID: 2668761909 Enrollment ID: I20160510001309 |
| Provider Name | Cheryl Ann Mefford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225378128 PECOS PAC ID: 4385922244 Enrollment ID: I20161027000496 |
| Provider Name | Tiffanie D Conley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225403207 PECOS PAC ID: 0143509893 Enrollment ID: I20161121000601 |
| Provider Name | Bernetta Southwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164833034 PECOS PAC ID: 1456638568 Enrollment ID: I20170427000773 |
| Provider Name | Adam Matthew Maggard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700292315 PECOS PAC ID: 0244590198 Enrollment ID: I20180214001234 |
| Provider Name | Tammy R. Melton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922037316 PECOS PAC ID: 4284981879 Enrollment ID: I20180730000355 |
| Provider Name | Evelyn Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295397800 PECOS PAC ID: 3375879190 Enrollment ID: I20190731001690 |
| Provider Name | Crystal Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285051383 PECOS PAC ID: 3072907294 Enrollment ID: I20220303000746 |
| Provider Name | Kevin Deaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437749926 PECOS PAC ID: 2466830633 Enrollment ID: I20220531000507 |
| Provider Name | Jasmine T Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265911879 PECOS PAC ID: 3476925207 Enrollment ID: I20230203002333 |
| Provider Name | Tracy Yonts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154621886 PECOS PAC ID: 5395194757 Enrollment ID: I20240112001166 |
| Provider Name | Christie Lynn Turner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063450468 PECOS PAC ID: 1052469855 Enrollment ID: I20240117001154 |
| Provider Name | Donna Marie Tuttle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689849614 PECOS PAC ID: 0345692109 Enrollment ID: I20240117001309 |
| Provider Name | Amanda Gail Wooton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871155705 PECOS PAC ID: 3072965623 Enrollment ID: I20240118003437 |
| Provider Name | Carrie Lawson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154719813 PECOS PAC ID: 4789036351 Enrollment ID: I20240118004124 |
| Provider Name | Erika Feltner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972990661 PECOS PAC ID: 3678925245 Enrollment ID: I20240118004197 |
| Provider Name | Tracey Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366869596 PECOS PAC ID: 5193177343 Enrollment ID: I20240123004214 |
| Provider Name | Amanda Wilder |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316429129 PECOS PAC ID: 7315399573 Enrollment ID: I20240123004467 |
| Provider Name | Dreama Wooton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003168949 PECOS PAC ID: 5294188447 Enrollment ID: I20240124002825 |
| Provider Name | Mikka Trent |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164985123 PECOS PAC ID: 7315390317 Enrollment ID: I20240125003706 |
| Provider Name | Pamela Rios |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083925010 PECOS PAC ID: 5597118430 Enrollment ID: I20240127000057 |
| Provider Name | Lindsey Slone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285992339 PECOS PAC ID: 2567805856 Enrollment ID: I20240202002597 |
| Provider Name | Jessica Muncy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083079107 PECOS PAC ID: 0345683587 Enrollment ID: I20240205003586 |
| Provider Name | Dawn Elkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922606680 PECOS PAC ID: 8123461282 Enrollment ID: I20240206003491 |
| Provider Name | Brittany Barrett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336488949 PECOS PAC ID: 6608219571 Enrollment ID: I20240207002730 |
| Provider Name | Courtney Patrick Hall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497049068 PECOS PAC ID: 9133434103 Enrollment ID: I20240208000605 |
| Provider Name | Laura Holliday-ritchie |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225144074 PECOS PAC ID: 5496198236 Enrollment ID: I20240208001009 |
| Provider Name | Phillip L Mosley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740396548 PECOS PAC ID: 5092158881 Enrollment ID: I20240208002593 |
| Provider Name | Randall Kloth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215977319 PECOS PAC ID: 7517016702 Enrollment ID: I20240216002613 |
| Provider Name | David Randall Gayheart |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1275270555 PECOS PAC ID: 7618328303 Enrollment ID: I20240226000464 |
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