NPIMap

Organization Active NPI

Emerald Therapy Center, LLC

  • Community/Behavioral Health Agency
  • Paducah, KY
National Provider Identifier
1619340387
Registry record updated Sep 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
EMERALD THERAPY CENTER, LLC
Practice address
5050 Village Square Dr Ste B
Paducah, KY 42001-7552
Phone
(270) 534-5128
Fax
(270) 477-0007
NPI assigned
Nov 3, 2015
Last updated
Sep 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2024

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

Authorized official

Name
Shelly Baer, LCSWNPI 1396273272
Title
Therapist
Phone
(270) 534-5128

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

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

Mailing address

5050B Village Square Dr
Paducah, KY 42001-9499
Phone (270) 217-2058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210827002743 KY Part B Supplier - Clinic/Group Practice 6103241211 Receives reassigned benefits from 18 practitioners
Practice locations: Paducah, KY; Murray, KY; Mayfield, KY

National Provider Directory

National Provider Directory

Locations

131 Nahm St
Ste 1
Paducah, KY 42001
Phone (270) 538-0851

3227 Coleman Rd
Paducah, KY 42001
Phone (270) 442-6399

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726358400000",
    "number": "1619340387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050B VILLAGE SQUARE DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420019499",
            "telephone_number": "270-217-2058",
            "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": {
        "organization_name": "EMERALD THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-03",
        "last_updated": "2024-09-15",
        "certification_date": "2024-09-15",
        "status": "A",
        "authorized_official_last_name": "BAER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "270-534-5128",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.