Provider Demographics
NPI:1417374943
Name:ESSENTIAL HEALING IOP, INC
Entity type:Organization
Organization Name:ESSENTIAL HEALING IOP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, NCC, LPCC
Authorized Official - Phone:859-687-0416
Mailing Address - Street 1:1795 ALYSHEBA WAY
Mailing Address - Street 2:1001
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2282
Mailing Address - Country:US
Mailing Address - Phone:859-687-0416
Mailing Address - Fax:
Practice Address - Street 1:1795 ALYSHEBA WAY
Practice Address - Street 2:1001
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2282
Practice Address - Country:US
Practice Address - Phone:859-687-0416
Practice Address - Fax:859-353-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 102L00000X, 103K00000X, 1041C0700X, 176P00000X, 251S00000X, 363LP0808X, 364SP0808X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No176P00000XOther Service ProvidersFuneral DirectorGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY800171OtherBHSO - BEHAVIORAL HEALTH SERVICES ORGANIZATION
KY810448OtherAODE - ALCOHOL AND OTHER DRUG ENTITY
KY7100294500Medicaid