NPIMap

Organization Active NPI

Dr. William H. Fuller Memorial Substance Abuse Treatment Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mayfield, KY
National Provider Identifier
1164964201
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
810023 Issued in KY
Legal business name
DR. WILLIAM H. FULLER MEMORIAL SUBSTANCE ABUSE TREATMENT CENTER
Practice address
1525 Cuba Rd
Mayfield, KY 42066-6809
Phone
(270) 247-2588
Fax
(270) 247-0142
NPI assigned
Nov 7, 2016
Organization subpart
Yes
Parent organization
WESTERN KY REGIONAL MHMR BOARD INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Authorized official

Name
Mr. Terry Hudspeth, MSSW
Title
President/Ceo
Phone
(270) 441-2171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 810023 KY Primary

Addresses

Primary practice location

1525 Cuba Rd
Mayfield, KY 42066-6809

Mailing address

1525 Cuba Rd
Mayfield, KY 42066-6809

Other identifiers 1

IdentifierTypeStateIssuer
27001015MedicaidKY

Other names 1

  • Four Rivers Behavioral Health Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1036584William H Fuller Memorial Services Center1525 Cuba Road, Mayfield, KY 42066Certificate of waiverFeb 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
W Ky Reg MH-Mr Board8 organizations share this tax ID, including this one
Part of
W Ky Reg MH-Mr Board

Other organizations with this tax ID 7

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

Locations

1525 Cuba Rd
Mayfield, KY 42066
Phone (270) 247-2588

NPI Registry JSON

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

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1164964201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 CUBA RD",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420666809",
            "fax_number": "270-247-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 CUBA RD",
            "city": "MAYFIELD",
            "state": "KY",
            "postal_code": "420666809",
            "telephone_number": "270-247-2588",
            "fax_number": "270-247-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. WILLIAM H. FULLER MEMORIAL SUBSTANCE ABUSE TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN KY REGIONAL MHMR BOARD INC",
        "enumeration_date": "2016-11-07",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "HUDSPETH",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "270-441-2171",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "KY",
            "license": "810023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27001015",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Rivers Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Four Rivers Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mayfield, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.