Kevin Willoughby, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1276 Issued in KY

Practice address

380 Suwannee Trail Street
Bowling Green, KY 42103

Phone

(270) 901-5000

Fax

(270) 842-6553

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1093825473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "238 CUMBERLAND CIR",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421039008",
            "telephone_number": "270-901-5000",
            "fax_number": "270-842-5268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 SUWANNEE TRAIL STREET",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42103",
            "telephone_number": "270-901-5000",
            "fax_number": "270-842-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "KEVIN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "1276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jana Willis, MS RD LDN
• Jayna Nichole Willis, M.S. CCC-SLP
• Jeramy C. Willis, KCSA
• Susan Emily Willis
• Tammy L Willis, DMD
• Steffan Willoughby, PEER SUPPORT SPEC.
• Noah Wills
• Wilson Counseling LLC
• Wilson Counseling, LLC
• Alexis Renee Wilson

• Clinical Social Worker in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.