Active NPI
Kimberly Roberts
- Mental Health Counselor
- Lexington, KY
National Provider Identifier
1295162022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1041C0700X
- Practice address
- 366 Waller Ave Ste 103
Lexington, KY 40504-2920 - Phone
- (859) 317-2051
- Fax
- (859) 317-6495
- NPI assigned
- Oct 11, 2013
- Last updated
- Dec 10, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1041C0700X | KY | Primary |
Addresses
Primary practice location
366 Waller Ave Ste 103
Lexington, KY 40504-2920
Mailing address
700 Hope Hill Rd
Hope, KY 40334-7002
Phone (859) 317-2051
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4974776 | Other | KY | CIGNA BEHAVIORAL HEALTHCARE |
| 5007654 | Other | KY | PASSPORT HEALTH PLAN |
| 7100292090 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1041C0700X | KY | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Behavioral Health & Counseling | Current | Accepting new patients | |
| Commonwealth Behavioral Health & Counseling | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418169600000",
"number": "1295162022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 HOPE HILL RD",
"city": "HOPE",
"state": "KY",
"postal_code": "403347002",
"telephone_number": "859-317-2051",
"fax_number": "859-317-6495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "366 WALLER AVE STE 103",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405042920",
"telephone_number": "859-317-2051",
"fax_number": "859-317-6495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "KIMBERLY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-10-11",
"last_updated": "2014-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "KY",
"license": "1041C0700X",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTHCARE",
"identifier": "4974776",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT HEALTH PLAN",
"identifier": "5007654",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100292090",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.