NPIMap

Organization Active NPI

Supportive Roads Mentoring Program Incorporated

  • Voluntary or Charitable Agency
  • Bowling Green, KY
National Provider Identifier
1114691409
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
Legal business name
SUPPORTIVE ROADS MENTORING PROGRAM INCORPORATED
Practice address
901 Beauty Ave
Bowling Green, KY 42101-6135
Phone
(270) 599-1034
Fax
(270) 599-1035
NPI assigned
Aug 2, 2021
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Cynthia Mackey, LPCCNPI 1326498403
Title
Ceo
Phone
(270) 599-1034

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X Primary

Addresses

Primary practice location

901 Beauty Ave
Bowling Green, KY 42101-6135

Mailing address

901 Beauty Ave
Bowling Green, KY 42101-6135
Phone (270) 599-1034

National Provider Directory

National Provider Directory

Locations

901 Beauty Ave
Bowling Green, KY 42101
Phone (270) 599-1034

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1114691409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 BEAUTY AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421016135",
            "telephone_number": "270-599-1034",
            "fax_number": "270-599-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 BEAUTY AVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421016135",
            "telephone_number": "270-599-1034",
            "fax_number": "270-599-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE ROADS MENTORING PROGRAM INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2025-09-11",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "MACKEY",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "270-599-1034",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.