Provider Demographics
NPI:1063899789
Name:BLUEGRASS PROFESSIONAL COUNSELING, LLC
Entity type:Organization
Organization Name:BLUEGRASS PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-696-3181
Mailing Address - Street 1:103 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9023
Mailing Address - Country:US
Mailing Address - Phone:270-696-3181
Mailing Address - Fax:877-308-1668
Practice Address - Street 1:103 EAST SOUTH STREET
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765
Practice Address - Country:US
Practice Address - Phone:270-696-3181
Practice Address - Fax:877-308-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6908104100000X
KY00211339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100326630Medicaid
KY7100366710Medicaid