Provider Demographics
NPI:1154877132
Name:NEWSOME, BENJAMIN (EDS, LPC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 DANADA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2731
Mailing Address - Country:US
Mailing Address - Phone:740-701-6689
Mailing Address - Fax:
Practice Address - Street 1:BLUEGRASS CARE CLINIC
Practice Address - Street 2:740 S. LIMESTONE L511
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-218-3815
Practice Address - Fax:859-257-4953
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY165327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional