Individual provider Active NPI

Evan Jonathan Holcomb, LCSW

  • Clinical Social Worker
  • Prestonsburg, KY
National Provider Identifier
1265818520
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
253263 Issued in KY
Practice address
104 S Front Ave
Prestonsburg, KY 41653-1614
Phone
(606) 886-8572
Fax
(606) 886-4433
NPI assigned
Aug 9, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 7296 KY
Clinical Social Worker 1041C0700X 253263 KY Primary

Addresses

Primary practice location

104 S Front Ave
Prestonsburg, KY 41653-1614

Mailing address

104 S Front Ave
Prestonsburg, KY 41653-1614
Phone (606) 886-8572

Other practice location 1

1925 Frederica St Ste 200
Owensboro, KY 42301-4818
Phone (270) 926-2484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181102001152 KY Practitioner - Clinical Social Worker 5799038048 Reassigns benefits to 2 organizations
I20260206003779 IN Practitioner - Clinical Social Worker 5799038048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Hospital, Inc.Group PAC ID 9032021431, 410 clinicians

Practice addresses (Care Compare)

445 N Cross Pointe Blvd
Evansville, IN 47715-4013
Phone (812) 476-7200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7296KYMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Comprehensive Care Center, Inc. CurrentSince Feb 19, 2024 Accepting new patients
Deaconess Hospital, Inc Clinical CurrentSince Jan 6, 2026 Accepting new patients
Mountain Comprehensive Care Center, Inc. CurrentSince Feb 19, 2024 Accepting new patients
Deaconess Hospital Inc Clinical CurrentSince Jan 6, 2026 Accepting new patients
Truenorth Treatment Center, LLC Clinical CurrentSince Dec 9, 2019 Accepting new patients

Locations

445 N Cross Pointe Blvd
Evansville, IN 47715
Phone (812) 402-2003

7200 E Indiana St
Evansville, IN 47715
Phone (812) 476-7200

121 E 2nd St
Ste 401
Owensboro, KY 42303
Phone (270) 240-1785

1100 Walnut St
Owensboro, KY 42301
Phone (270) 689-6500

838 S Mayo Trl
Paintsville, KY 41240
Phone (606) 788-1345

104 S Front Ave
Prestonsburg, KY 41653
Phone (606) 688-6857

Organizations & group practices 6

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": "1439078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1265818520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S FRONT AVE",
            "city": "PRESTONSBURG",
            "state": "KY",
            "postal_code": "416531614",
            "telephone_number": "606-886-8572",
            "fax_number": "606-886-4433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1925 Frederica St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423014818",
            "country_code": "US",
            "telephone_number": "270-926-2484",
            "fax_number": "270-685-6015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HOLCOMB",
        "first_name": "EVAN",
        "middle_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-09",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "KY",
            "license": "7296",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "253263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prestonsburg, KY

Sources for this page

Verify at the official NPI Registry.