Christa Leeanne Wiley, LPCC
Individual provider Active NPI Counselor · Rush, KY
NPI 1295160992 · NPPES record last updated Sep 12, 2013
Key facts
- NPI
- 1295160992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 0936 (KY)
- Practice address
- 2901 Pigeon Roost Rd
Rush, KY 41168-8132 - Phone
- (606) 928-6648
- Fax
- (606) 928-2973
- NPI assigned
- Sep 12, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ashland Integrative Medicine LLC
Practice addresses (Care Compare)
10730 Midland Trail Rd
Ashland, KY 41102-9679
Phone (606) 393-6193
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241121003177 | KY | Practitioner - Mental Health Counselor | 8628339678 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ashland Integrative Medicine LLC | Current |
Accepting new patients | |
| Aim Behavioral | Past | Accepting new patients |
Locations
10730 Midland Trail Rd
Ashland, KY 41102
Phone (606) 393-6193
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0936 | KY | Yes |
Addresses
Primary practice location
2901 Pigeon Roost Rd
Rush, KY 41168-8132
Mailing address
2901 Pigeon Roost Rd
Rush, KY 41168-8132
Phone (606) 928-6648
Other providers in Rush, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.