NPIMap

Organization Active NPI

Integrative Psychology & Counseling Specialists

  • Clinical Psychologist
  • Campbellsville, KY
National Provider Identifier
1245767938
Registry record updated May 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
130473 Issued in KY
Legal business name
INTEGRATIVE PSYCHOLOGY & COUNSELING SPECIALISTS
Practice address
102 Winston Way
Suite a
Campbellsville, KY 42718-1593
Phone
(270) 215-2373
Fax
(888) 975-1981
NPI assigned
May 12, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2017

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

Authorized official

Name
Mrs. Abrielle Dawn Conway, PSCNPI 1245641547
Title
Owner, Licesned Psychologist
Phone
(270) 215-2373

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 106483 KY
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 130473 KY Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X KY1771 KY

Addresses

Primary practice location

102 Winston Way
Suite a
Campbellsville, KY 42718-1593

Mailing address

102 Winston Way
Suite a
Campbellsville, KY 42718-1593
Phone (270) 215-2373

Other identifiers 2

IdentifierTypeStateIssuer
7100323430MedicaidKY
130473OtherKYMEDICAL LICENSE

National Provider Directory

National Provider Directory

Locations

102 Winston Way
Ste A
Campbellsville, KY 42718
Phone (270) 215-2373

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1494547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494547200000",
    "number": "1245767938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WINSTON WAY",
            "address_2": "SUITE A",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181593",
            "telephone_number": "270-215-2373",
            "fax_number": "888-975-1981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 WINSTON WAY",
            "address_2": "SUITE A",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427181593",
            "telephone_number": "270-215-2373",
            "fax_number": "888-975-1981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PSYCHOLOGY & COUNSELING SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-12",
        "last_updated": "2017-05-12",
        "status": "A",
        "authorized_official_last_name": "CONWAY",
        "authorized_official_first_name": "ABRIELLE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER, LICESNED PSYCHOLOGIST",
        "authorized_official_telephone_number": "270-215-2373",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PSC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "KY",
            "license": "106483",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "130473",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "KY1771",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100323430",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "130473",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; 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.