Kim Sego Tully, LCSW, Psychotherapy Services

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3167 Issued in KY

Legal business name

KIM SEGO TULLY, LCSW, PSYCHOTHERAPY SERVICES

Practice address

240 W Dixie Ave
Suite 5-B
Elizabethtown, KY 42701-1586

Phone

(270) 307-3672

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Kimberly Sego Tully, LCSW

Title

Sole Member

Phone

(270) 307-3672

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Practitioners 2

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

• Kimberly Becker, LCSW

  • Clinical Social Worker
  • Elizabethtown, KY
  • NPI 1760420459
  Medicare reassignment
• Nicholas Watters, PSYD

  • Clinical Psychologist
  • Elizabethtown, KY
  • NPI 1063468817
  NPD (past)

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493683200000",
    "number": "1811231897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 RUE LA GRANDE",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427013135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W DIXIE AVE",
            "address_2": "SUITE 5-B",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427011586",
            "telephone_number": "270-307-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIM SEGO TULLY, LCSW, PSYCHOTHERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2017-05-02",
        "status": "A",
        "authorized_official_last_name": "TULLY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "SEGO",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "270-307-3672",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "3167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Michael Anthony Kidwell, PT, DPT
• Michael Keith Kimble, DDS
• Kasey Kindervater, APRN
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• Ashley King-Tinsley, DMD
• Kaitlyn Dawn King

• Clinical Social Worker in Elizabethtown, KY
• Providers in Elizabethtown, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2017; 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.