Active NPI
Samantha Upshaw Maxey
- Professional Counselor
- Richmond, KY
National Provider Identifier
1083997886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 104439
- Practice address
- 332 Highland Park Dr
Richmond, KY 40475-3487 - Phone
- (859) 200-4961
- NPI assigned
- Sep 28, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1320 | KY | |
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | 104439 | KY | Primary |
Addresses
Primary practice location
332 Highland Park Dr
Richmond, KY 40475-3487
Mailing address
332 Highland Park Dr
Richmond, KY 40475-3487
Phone (859) 200-4961
Other practice location 1
415 Stonecrest Rd
Winchester, KY 40391-8320
Phone (513) 594-3360
Other practice location 2
900 Beasley St
Lexington, KY 40509-4266
Phone (606) 356-4517
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12789901 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104439 | KY | MD | Professional Counselor |
| 1320 | KY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1083997886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "332 HIGHLAND PARK DR",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404753487",
"telephone_number": "859-200-4961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "332 HIGHLAND PARK DR",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404753487",
"telephone_number": "859-200-4961"
}
],
"practiceLocations": [
{
"address_1": "415 Stonecrest Rd",
"address_purpose": "LOCATION",
"city": "Winchester",
"state": "KY",
"postal_code": "403918320",
"country_code": "US",
"telephone_number": "513-594-3360",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "900 Beasley St",
"address_purpose": "LOCATION",
"city": "Lexington",
"state": "KY",
"postal_code": "405094266",
"country_code": "US",
"telephone_number": "606-356-4517",
"fax_number": "606-435-0817",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "UPSHAW MAXEY",
"first_name": "SAMANTHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-28",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "1320",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "104439",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12789901",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.