Active NPI
Prodigal Ministries, LLC
- Mental Health Counselor
- Buckner, KY
National Provider Identifier
1013662717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- PRODIGAL MINISTRIES, LLC
- Practice address
- 4414 Old Lagrange Rd
Buckner, KY 40010-9547 - Phone
- (502) 222-2389
- NPI assigned
- Feb 21, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nina J Roy
- Title
- Reconciliation Director
- Phone
- (270) 585-4306
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Substance Abuse Rehabilitation Facility | 324500000X |
Addresses
Primary practice location
4414 Old Lagrange Rd
Buckner, KY 40010-9547
Mailing address
PO Box 1484
Crestwood, KY 40014-1484
Other practice location 1
256 Main St Ste B
Florence, KY 41042-2050
Phone (502) 222-2389
Other practice location 2
121 W Oak St
Louisville, KY 40203-2813
Phone (502) 222-2389
Other practice location 3
6501 W Highway 22
Crestwood, KY 40014-9317
Phone (502) 222-2389
Other names 2
- PRODIGAL COUNSELING SERVICES
- Prodigal Ministries
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231121000960 | KY | Part B Supplier - Clinic/Group Practice | 2860840493 |
Receives reassigned benefits from 7 practitioners Practice locations: Buckner, KY |
National Provider Directory
National Provider Directory- Tax ID family
- Prodigal Counseling Services
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Professional Counselor
- Florence, KY
- NPI 1376313973
Locations
2865 Chancellor Dr
Ste 225
Crestview Hills, KY 41017
Phone (859) 341-5400
51 Cavalier Blvd
Ste 240
Florence, KY 41042
8134 New La Grange Rd
Louisville, KY 40222
121 W Oak St
Louisville, KY 40203
Phone (502) 222-2389
Practitioners & affiliated clinicians
Practitioners 19
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Professional Counselor
- Florence, KY
- NPI 1285973164
KY, Mental Health
-
- Case Management Agency
- Buckner, KY
- NPI 1174247159
-
- Counselor
- Buckner, KY
- NPI 1134969298
-
- Peer Specialist
- Buckner, KY
- NPI 1619741972
-
- Addiction (Substance Use Disorder) Counselor
- Louisville, KY
- NPI 1609563006
-
- Addiction (Substance Use Disorder) Counselor
- Buckner, KY
- NPI 1336864115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645401600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1702339200000",
"number": "1013662717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1484",
"city": "CRESTWOOD",
"state": "KY",
"postal_code": "400141484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4414 OLD LAGRANGE RD",
"city": "BUCKNER",
"state": "KY",
"postal_code": "400109547",
"telephone_number": "502-222-2389"
}
],
"practiceLocations": [
{
"address_1": "256 Main St Ste B",
"address_purpose": "LOCATION",
"city": "Florence",
"state": "KY",
"postal_code": "410422050",
"country_code": "US",
"telephone_number": "502-222-2389",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "121 W Oak St",
"address_purpose": "LOCATION",
"city": "Louisville",
"state": "KY",
"postal_code": "402032813",
"country_code": "US",
"telephone_number": "502-222-2389",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6501 W Highway 22",
"address_purpose": "LOCATION",
"city": "Crestwood",
"state": "KY",
"postal_code": "400149317",
"country_code": "US",
"telephone_number": "502-222-2389",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "PRODIGAL MINISTRIES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-02-21",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A",
"authorized_official_last_name": "ROY",
"authorized_official_first_name": "NINA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "RECONCILIATION DIRECTOR",
"authorized_official_telephone_number": "270-585-4306"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "PRODIGAL COUNSELING SERVICES",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Prodigal Ministries",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Prodigal Ministries",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Buckner, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.