Individual provider Active NPI

Samantha Jones

  • Mental Health Counselor
  • Paducah, KY
National Provider Identifier
1225684335
Registry record updated Jul 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
276312 Issued in KY
Practice address
5050 Village Square Dr Ste B
Paducah, KY 42001-7552
Phone
(270) 534-5128
Fax
(270) 477-0007
NPI assigned
Aug 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X 276312 KY Primary

Addresses

Primary practice location

5050 Village Square Dr Ste B
Paducah, KY 42001-7552

Mailing address

5050 Village Square Dr Ste B
Paducah, KY 42001-7552
Phone (270) 534-5128

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240716004348 KY Practitioner - Mental Health Counselor 8224573076 Reassigns benefits to 1 organization
Practice locations: Paducah, KY

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

131 Nahm St
Suite 9
Paducah, KY 42001-4362
Phone (270) 625-5005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
276312KYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Transitions LLC Mental Health CurrentSince Jan 1, 2025 Accepting new patients

Locations

131 Nahm St
Ste 9
Paducah, KY 42001
Phone (270) 443-9285

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1225684335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 VILLAGE SQUARE DR STE B",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017552",
            "telephone_number": "270-534-5128",
            "fax_number": "270-477-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 VILLAGE SQUARE DR STE B",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017552",
            "telephone_number": "270-534-5128",
            "fax_number": "270-477-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-14",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "276312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

Verify at the official NPI Registry.