| Lionheart Trauma Support Services, Llc | |
|
168 E Reynolds Rd. Suite 210 Lexington KY 40517 | |
| (859) 314-8786 | |
| Not Available |
| Full Name | Lionheart Trauma Support Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 168 E Reynolds Rd., Lexington, Kentucky |
| Authorized Official Name and Position | Katherine Linda Middleton (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 8593148786 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lionheart Trauma Support Services, Llc 168 E. Reynolds Rd. Ste 210 Lexingtion KY 40517 Ph: (859) 314-8786 | Lionheart Trauma Support Services, Llc 168 E Reynolds Rd. Suite 210 Lexington KY 40517 Ph: (859) 314-8786 |
| NPI Number | 1538638515 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 11/19/2018 |
| Medicare PECOS PAC ID | 5294071429 |
|---|---|
| Medicare Enrollment ID | O20190109002057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538638515 | NPI | - | NPPES |
| 7100479060 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Katherine Middleton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043699416 PECOS PAC ID: 0547506776 Enrollment ID: I20190109002177 |
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