DR. WILLIAM H. FULLER MEMORIAL SUBSTANCE ABUSE TREATMENT CENTER (NPI# 1164964201) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164964201 |
| Entity Type | Organization |
| Organization Name | DR. WILLIAM H. FULLER MEMORIAL SUBSTANCE ABUSE TREATMENT CENTER |
| Other Organization Name | FOUR RIVERS BEHAVIORAL HEALTH |
| Practice Address |
1525 Cuba Rd Mayfield KY 42066-6809 |
| Practice Telephone | 2702472588 |
| Practice Fax Number | 2702470142 |
| Mailing Fax Number | 2702470142 |
| Enumeration Date | 2016-11-07 |
| Last Update Date | 2020-08-31 |
| Authorized Official Name | MR. TERRY HUDSPETH (PRESIDENT/CEO) |
| Authorized Official Telephone | 2704412171 |
| Authorized Official Credential | MSSW |
| Is Organization Subpart | Y |
| Parent Organization Name | WESTERN KY REGIONAL MHMR BOARD INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
810023 | KY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 27001015 | 05 |
| Other Name | Type Code |
|---|---|
| Four Rivers Behavioral Health | Doing Business As Name - Organization |
| Street Address |
1525 CUBA RD |
| City | MAYFIELD |
| State | KY |
| Zip Code | 42066-6809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629492269 | Kimberly M Henson | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2014-02-18 |
| 1114527538 | Gena Gail Taylor-tidwell | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2020-10-26 |
| 1386275048 | Jena Aileen Thacker | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2020-01-31 |
| 1952932162 | Savanah Glen Wilkins Briggs | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2020-01-28 |
| 1477184554 | Terri Lynn Holland | Registered Nurse | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2020-01-28 |
| 1467006403 | Jeanneda Ann Gilbert | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2019-07-29 |
| 1760969455 | Marquetta L Johnson | Counselor | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2018-07-25 |
| 1003336736 | Leigh Ann Williams | Social Worker | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2017-06-23 |
| 1073052809 | Christina Maria Martin | Behavior Technician | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2017-02-13 |
| 1619413598 | Storm Corey | Social Worker | 1525 Cuba Rd, Mayfield, KY 42066-6809 | 2017-01-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760031959 | Snh Derby Tenant LLC | Assisted Living Facility | 1517 West Broadway Street, Mayfield, KY 42066 | 2019-09-10 |
| 1033674254 | Mind, Body, Soul, LLC | Clinic/Center | 1325 Us 45 S, Suite C, Mayfield, KY 42066 | 2019-02-01 |
| 1699288936 | Kimberly Kaye Gooch | Developmental Therapist | 3907 State Route 303, Mayfield, KY 42066 | 2017-11-08 |
| 1538604657 | Courtney L Coleman | Nurse Practitioner | 1029 Medical Center Cir Ste 200, Mayfield, KY 42066 | 2016-12-28 |
| 1659814721 | Bertha Workman | Voluntary or Charitable | 331 South 7th Street, Mayfield, KY 42066 | 2016-11-22 |
| 1699174052 | Laura Dassing | Counselor | 1325 Hwy 45 N, Mayfield, KY 42066 | 2014-08-21 |
| 1275947905 | Wkda Services LLC | Community/Behavioral Health | 1325 U S Hwy 45n, Mayfield, KY 42066 | 2014-06-20 |
| 1538594247 | Young Healthcare LLC | Chiropractor | 1011 Paris Road #341, Mayfield, KY 42066 | 2013-09-12 |
| 1811335649 | Donald Bennett Dowdy | Dentist | 236 N. 6th St., Mayfield, KY 42066 | 2013-06-14 |
| 1578822623 | Wanda Bingham Marshall | Counselor | 325 South 8th Street, West Kentucky Counseling Center, Mayfield, KY 42066 | 2012-05-10 |
| Find all providers in zip 42066 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033674254 | Mind, Body, Soul, LLC | Clinic/Center | 1325 Us 45 S, Suite C, Mayfield, KY 42066 | 2019-02-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730532 | Reflection In Practice Counseling and Consultation | Clinic/Center | 1355 Bardstown Rd, Louisville, KY 40204-1353 | 2020-11-03 |
| 1568069326 | Evolve Lou Counseling | Clinic/Center | 1309 Cecil Ave, Louisville, KY 40211-2418 | 2020-10-05 |
| 1265048748 | Therapy Pros, Inc. | Clinic/Center | 928 Idlewild Ct, Lexington, KY 40505-3634 | 2020-09-19 |
| 1538791165 | Bhg Lviii, LLC | Clinic/Center | 1000 Ace Drive, Berea, KY 40403-1327 | 2020-02-11 |
| 1538791140 | Bhg Lviii, LLC | Clinic/Center | 2705 Olivet Church Road, Paducah, KY 42001-9755 | 2020-02-11 |
| 1356987929 | Faraday Kentucky, LLC | Clinic/Center | 10000 Shelbyville Rd Ste 101, Louisville, KY 40223-2973 | 2019-11-19 |
| 1568004976 | Good Shepherd Institute of The Bluegrass | Clinic/Center | 307 W Dixie Ave, Elizabethtown, KY 42701-1701 | 2019-10-17 |
| 1831746767 | Journey Through Counseling LLC | Clinic/Center | 2614 Utah Dr, Bowling Green, KY 42104-4263 | 2019-08-26 |
| 1578020210 | The Family Healing Center, Inc | Clinic/Center | 241 East Main Street, Morehead, KY 40351 | 2019-03-01 |
| 1659841344 | Asymmetry Health | Clinic/Center | 501 Darby Creek Rd Ste 1, Lexington, KY 40509-1605 | 2018-11-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. WILLIAM H. FULLER MEMORIAL SUBSTANCE ABUSE TREATMENT CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.