NPIMap

Organization Active NPI

Prodigal Ministries, LLC

Doing business as Prodigal Counseling Services

  • Mental Health Counselor
  • Buckner, KY
National Provider Identifier
1013662717
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PRODIGAL MINISTRIES, LLC
Doing business as
Prodigal Counseling Services
Prodigal Ministries
Practice address
4414 Old Lagrange Rd
Buckner, KY 40010-9547
Phone
(502) 222-2389
NPI assigned
Feb 21, 2022
Last updated
Dec 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 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

121 W Oak St
Louisville, KY 40203-2813
Phone (502) 222-2389

Other practice location 2

6501 W Highway 22
Crestwood, KY 40014-9317
Phone (502) 222-2389

Other practice location 3

256 Main St Ste B
Florence, KY 41042-2050
Phone (502) 222-2389

Other names 2

  • PRODIGAL COUNSELING SERVICES Doing business as
  • Prodigal Ministries Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

256 Main St
Ste B
Florence, KY 41042
Phone (502) 222-2389

51 Cavalier Blvd
Ste 240
Florence, KY 41042

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, and the practitioner matching its NPPES authorized official.

View all 19

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": "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"
        },
        {
            "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"
        }
    ],
    "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.

Verify at the official NPI Registry.